Individual
KIMBERLY UDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
3602 MATLOCK RD STE 206, ARLINGTON, TX 76015-3600
(817) 468-1506
(817) 468-1520
Mailing address
3602 MATLOCK RD, 206, ARLINGTON, TX 76015
(817) 468-1506
(817) 468-1520
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
L1225
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10029987
AMERIGROUP
TX
05
—
165666201
—
TX
01
—
651198393
EMPLOYER TX ID NUMBER
TX
01
—
8P5630
BLUE CROSS BLUE SHIELD
TX
Enumeration date
10/20/2006
Last updated
05/29/2019
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