Provider Demographics
NPI:1689830804
Name:JOHNSON, KIMBERLY R (RN, NP-C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 DRYDEN RD
Mailing Address - Street 2:SUITE 850 MS:BCM620
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2400
Mailing Address - Country:US
Mailing Address - Phone:713-798-3967
Mailing Address - Fax:713-798-8317
Practice Address - Street 1:1709 DRYDEN RD
Practice Address - Street 2:SUITE 850 MS:BCM620
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2400
Practice Address - Country:US
Practice Address - Phone:713-798-3967
Practice Address - Fax:713-798-8317
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX687648163WC0200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L27078Medicare PIN
TXB105554Medicare PIN
TXP00829482Medicare PIN
TX8L26189Medicare PIN