Provider Demographics
NPI:1295749083
Name:LANE, KIMBERLEY RUTH (CPM, LM)
Entity type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:RUTH
Last Name:LANE
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11805 MEADOWGLEN LN
Mailing Address - Street 2:#2328
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2766
Mailing Address - Country:US
Mailing Address - Phone:901-292-4876
Mailing Address - Fax:
Practice Address - Street 1:11321 RICHMOND AVE
Practice Address - Street 2:M100, ATTN/HBMS - KIM LANE, LM, CPM
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-6668
Practice Address - Country:US
Practice Address - Phone:832-942-8324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99254176B00000X
UT000176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife