1154545291 NPI number — KIMBERLY S MEIXNER FNP

Table of content: KIMBERLY S MEIXNER FNP (NPI 1154545291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154545291 NPI number — KIMBERLY S MEIXNER FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEIXNER
Provider First Name:
KIMBERLY
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154545291
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 911230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75391-1230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-997-8000
Provider Business Mailing Address Fax Number:
972-234-2987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3410 WORTH ST
Provider Second Line Business Practice Location Address:
MEDICAL STAFF SERVICES
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75246-2006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-370-1300
Provider Business Practice Location Address Fax Number:
214-370-1313
Provider Enumeration Date:
04/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  653467 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AP113044 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 196879403 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 196879404 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 196879408 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 196879406 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 196879410 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8Y1767 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 196879405 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 196879407 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 196879412 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 196879401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 196879402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01898982 . This is a "RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 196879411 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 196879409 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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