Provider Demographics
NPI:1255375770
Name:PERSLEY, KIMBERLY M (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:M
Last Name:PERSLEY
Suffix:
Gender:F
Credentials:MD
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 35629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-0629
Mailing Address - Country:US
Mailing Address - Phone:214-424-2200
Mailing Address - Fax:214-231-2159
Practice Address - Street 1:8230 WALNUT HILL LN
Practice Address - Street 2:SUITE 610
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4482
Practice Address - Country:US
Practice Address - Phone:214-345-7398
Practice Address - Fax:214-345-4264
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6656207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118623107Medicaid
TX8S9975OtherBCBS
TXP00471453OtherRAIL ROAD MEDICARE
TX118623107Medicaid
TX8J1655Medicare PIN
TX118623107Medicaid