1760429849 NPI number — DR. KIMBERLY M PINSON-ERB DC

Table of content: DR. KIMBERLY M PINSON-ERB DC (NPI 1760429849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760429849 NPI number — DR. KIMBERLY M PINSON-ERB DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PINSON-ERB
Provider First Name:
KIMBERLY
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1760429849
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
255 S DENTON TAP RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
COPPELL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75019-5050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-556-9595
Provider Business Mailing Address Fax Number:
972-556-0118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 S DENTON TAP RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
COPPELL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-556-9595
Provider Business Practice Location Address Fax Number:
972-556-0118
Provider Enumeration Date:
05/31/2006

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: 111NN0400X , with the licence number:  7321 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 7321 , 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: 5223835 . This is a "FIRST HEALTH PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 828260 . This is a "BCBS PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 658710 . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5756609 . This is a "AETNA PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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