Provider Demographics
NPI:1053762070
Name:KIMMEL, RONALD G (FNP-C)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:G
Last Name:KIMMEL
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5573 SEABURY DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-5393
Mailing Address - Country:US
Mailing Address - Phone:817-897-7494
Mailing Address - Fax:
Practice Address - Street 1:2401 IRA E WOODS AVE
Practice Address - Street 2:STE. 600
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3997
Practice Address - Country:US
Practice Address - Phone:817-488-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily