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Individual
KIMBERLY CAROL VANDALEN
Active
Individual
KIMBERLY CAROL VANDALEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
AP129610
TX
2083P0901X
Public Health & General Preventive Medicine Physician
AP129610
TX
208D00000X
General Practice Physician
AP129610
TX
363LF0000X
Family Nurse Practitioner
AP129610
TX
363LF0000X
Family Nurse Practitioner
Primary
APRN.CNP.025839
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017801401
—
TX
05
—
0389946
—
OH
05
—
063389301
—
TX
05
—
083850001
—
TX
01
—
87V600
BCBS
TX
01
—
87V601
BCBS
TX
01
—
AP129610
TEXAS STATE LICENSE
TX
Enumeration date
11/12/2015
Last updated
10/22/2020
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