Provider Demographics
NPI:1831195312
Name:KOLLS, KIM RENEE (R-EEG-T, CNIM)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:RENEE
Last Name:KOLLS
Suffix:
Gender:F
Credentials:R-EEG-T, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HIGHLAND PARK VLG
Mailing Address - Street 2:STE 100-225
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205
Mailing Address - Country:US
Mailing Address - Phone:214-536-1647
Mailing Address - Fax:214-580-7600
Practice Address - Street 1:25 HIGHLAND PARK VLG STE 100-225
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-2789
Practice Address - Country:US
Practice Address - Phone:214-536-1647
Practice Address - Fax:214-580-7600
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3404246ZE0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEG
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3407OtherR-EEG-T