Individual
DR. KIMBERLY PROCELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
615 RUSSELL BLVD, NACOGDOCHES, TX 75965-1247
(936) 564-1740
Mailing address
615 RUSSELL BLVD, NACOGDOCHES, TX 75965-1247
(936) 564-1740
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
M1298
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00M37MT
BLUE CROSS
TX
05
—
1748857-01
—
TX
Enumeration date
03/22/2006
Last updated
06/12/2024
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