Provider Demographics
NPI:1780300319
Name:KIMOTHO, TERESA WAIRIMU (FNP)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:WAIRIMU
Last Name:KIMOTHO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:TERESA
Other - Middle Name:WAIRIMU
Other - Last Name:KIMOTHO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TERESA KIMOTHO
Mailing Address - Street 1:9423 EVERTON
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-1650
Mailing Address - Country:US
Mailing Address - Phone:443-240-5967
Mailing Address - Fax:
Practice Address - Street 1:5107 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4801
Practice Address - Country:US
Practice Address - Phone:210-692-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1096910363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily