Individual
KIMBERLY S TYNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2504 RIDGE RD, SUITE 201, ROCKWALL, TX 75087-2569
(972) 722-5959
(972) 722-5538
Mailing address
PO BOX 871, TERRELL, TX 75160-0017
(972) 722-5959
(972) 722-5538
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
L5594
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00864T
MEDICARE GROUP PTAN
TX
05
—
100512421
—
NV
05
—
160462101
—
TX
05
—
160462102
—
TX
Enumeration date
08/15/2006
Last updated
02/26/2013
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