Provider Demographics
NPI:1174145494
Name:WEBER, KIM M (ARNP)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:M
Last Name:WEBER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:M
Other - Last Name:MIKULENCAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:718 N EAST ST # 270
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-4724
Mailing Address - Country:US
Mailing Address - Phone:903-251-9851
Mailing Address - Fax:903-865-5722
Practice Address - Street 1:5575 WARREN PKWY STE 115
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4063
Practice Address - Country:US
Practice Address - Phone:903-251-9851
Practice Address - Fax:903-865-5722
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144615363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology