Provider Demographics
NPI:1134433063
Name:RUIZ, KIMBERLY KAY (FNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAY
Last Name:RUIZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W ARBROOK BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-3180
Mailing Address - Country:US
Mailing Address - Phone:972-647-8404
Mailing Address - Fax:972-641-8398
Practice Address - Street 1:400 W ARBROOK BLVD STE 300
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-3180
Practice Address - Country:US
Practice Address - Phone:972-647-8404
Practice Address - Fax:972-641-8398
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX693642363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB147360Medicare PIN
TXTXB147596Medicare PIN
TXB147362Medicare PIN