Provider Demographics
NPI:1255043519
Name:TIMS, MONNIE KATE (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:MONNIE
Middle Name:KATE
Last Name:TIMS
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:TIMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IBCLC
Mailing Address - Street 1:513 SADDLEBACK RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-4572
Mailing Address - Country:US
Mailing Address - Phone:817-683-1106
Mailing Address - Fax:
Practice Address - Street 1:6850 AUSTIN CENTER BLVD STE 225
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3293
Practice Address - Country:US
Practice Address - Phone:512-846-6455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL-310420174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN