Provider Demographics
NPI:1740857077
Name:THERIOT, KYMBERLY
Entity type:Individual
Prefix:MS
First Name:KYMBERLY
Middle Name:
Last Name:THERIOT
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 1:7413 HUMMINGBIRD LN # 128
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-3621
Mailing Address - Country:US
Mailing Address - Phone:832-869-0507
Mailing Address - Fax:
Practice Address - Street 1:7413 HUMMINGBIRD LN # 128
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-3621
Practice Address - Country:US
Practice Address - Phone:832-869-0507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver