Provider Demographics
NPI:1255363800
Name:CULLAR, KYMBERLY KIRK (FNP)
Entity type:Individual
Prefix:
First Name:KYMBERLY
Middle Name:KIRK
Last Name:CULLAR
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:PO BOX 9889
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-9566
Mailing Address - Country:US
Mailing Address - Phone:940-264-1212
Mailing Address - Fax:940-264-1213
Practice Address - Street 1:4722 TAFT BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-4800
Practice Address - Country:US
Practice Address - Phone:940-322-5477
Practice Address - Fax:940-720-0018
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX554888363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS36821Medicare UPIN
TX8L2518Medicare PIN