Organization
KIMBERLY TYNER MD, PA
Active
Other names
NEW LIFE OB/GYN
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY S TYNER MD (PRESIDENT)
(972) 878-9400
Entity
Organization
Contact information
Practice address
601 S CLAY ST, SUITE 104, ENNIS, TX 75119-5771
(972) 878-9400
(972) 878-9403
Mailing address
601 S CLAY ST, SUITE 104, ENNIS, TX 75119-5771
(972) 878-9400
(972) 878-9403
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00451V
BLUE CROSS BLUE SHIELD
—
Enumeration date
08/15/2006
Last updated
08/22/2020
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