Provider Demographics
NPI:1255624730
Name:BIENVENUE, KIMBERLEY MARIE
Entity type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:MARIE
Last Name:BIENVENUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11314 WICKERSHAM LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-6826
Mailing Address - Country:US
Mailing Address - Phone:281-221-0256
Mailing Address - Fax:832-288-3640
Practice Address - Street 1:11314 WICKERSHAM LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-6826
Practice Address - Country:US
Practice Address - Phone:281-221-0256
Practice Address - Fax:832-288-3640
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX637494172A00000X, 3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No172A00000XOther Service ProvidersDriver