Provider Demographics
NPI:1720757180
Name:RICHARD, KIMBERLY (PHLEBOTOMY)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:RICHARD
Suffix:
Gender:F
Credentials:PHLEBOTOMY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 N SAM HOUSTON PKWY E APT 2104
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77032-4051
Mailing Address - Country:US
Mailing Address - Phone:832-591-8004
Mailing Address - Fax:
Practice Address - Street 1:5301 N SAM HOUSTON PKWY E APT 2104
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77032-4051
Practice Address - Country:US
Practice Address - Phone:832-591-8004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69083246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy