Individual
MRS. KIMBERLY LYNN KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4450 HIGHLAND AVE, BEAUMONT, TX 77705
(832) 548-5000
(409) 242-2526
Mailing address
PO BOX 66308, HOUSTON, TX 77266-6308
(832) 548-5000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP114235
TX
363LF0000X
Family Nurse Practitioner
AP114235
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080462703
LEGACY COMMUNITY HEALTH SERVICES, INC. MEDICAID NUMBER
TX
01
—
741809
LEGACY COMMUNITY HEALTH SERVICES INC SITE SPECIFIC MEDICARE
—
01
—
AP114235
TEXAS NURSING LICENSE
TX
Enumeration date
08/31/2006
Last updated
04/01/2019
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