Provider Demographics
NPI:1295799880
Name:KIMBROW, NANCY LEONA (M D)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:LEONA
Last Name:KIMBROW
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 S OLD BETSY RD
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:TX
Mailing Address - Zip Code:76059-2427
Mailing Address - Country:US
Mailing Address - Phone:817-641-8141
Mailing Address - Fax:817-558-2305
Practice Address - Street 1:212 S OLD BETSY RD
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:TX
Practice Address - Zip Code:76059-2427
Practice Address - Country:US
Practice Address - Phone:817-641-8141
Practice Address - Fax:817-558-2305
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092659401Medicaid
B23959Medicare UPIN
TX092659401Medicaid