Provider Demographics
NPI:1295728228
Name:WALDROP, KIMBERLY (AUD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:WALDROP
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:METCALF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:19950 HUEBNER RD
Mailing Address - Street 2:#506
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3292
Mailing Address - Country:US
Mailing Address - Phone:210-617-5300
Mailing Address - Fax:210-617-5200
Practice Address - Street 1:7400 MERTON MINTER BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4404
Practice Address - Country:US
Practice Address - Phone:210-617-5300
Practice Address - Fax:210-617-5200
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51238231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00134880OtherMEDICARE RAILROAD
TX80290AOtherBLUE CROSS BLUE SHIELD
TXP00134880OtherMEDICARE RAILROAD