Provider Demographics
NPI:1992155477
Name:GUZMAN, KIMBERLY THERIOT (NP)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:THERIOT
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 ELIZABETH ST STE 502
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2224
Mailing Address - Country:US
Mailing Address - Phone:361-883-3831
Mailing Address - Fax:361-887-0146
Practice Address - Street 1:613 ELIZABETH ST STE 502
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2224
Practice Address - Country:US
Practice Address - Phone:361-861-1890
Practice Address - Fax:361-887-0146
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131159363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX510011YLPSOtherWELLMED PTAN
TX358837801Medicaid