Individual
KIMBERLEE MICHELLE DELCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
12222 MERIT DR STE 600, DALLAS, TX 75251-3294
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 840853, DALLAS, TX 75284-9803
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
RN.429575
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
1128197
TX
367500000X
Certified Registered Nurse Anesthetist
APRN.CRNA.0020462
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
MEDICAID PTAN
OH
05
—
PENDING
—
OH
Enumeration date
06/30/2021
Last updated
09/08/2023
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