Provider Demographics
NPI:1669746772
Name:CALLOWAY, KIMBEREY (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:KIMBEREY
Middle Name:
Last Name:CALLOWAY
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15283
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76119-0283
Mailing Address - Country:US
Mailing Address - Phone:682-301-2844
Mailing Address - Fax:
Practice Address - Street 1:5125 WICHITA ST
Practice Address - Street 2:15283
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-2541
Practice Address - Country:US
Practice Address - Phone:682-301-2844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX975583101YM0800X, 163WC0400X, 163WC1500X, 163WP0807X, 163WP0808X, 171400000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & AdolescentGroup - Single Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty
No171400000XOther Service ProvidersHealth & Wellness Coach