Provider Demographics
NPI:1114250651
Name:GIBERGA, KIMBERLY FIELDS
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:FIELDS
Last Name:GIBERGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8380 FM 78
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-1057
Mailing Address - Country:US
Mailing Address - Phone:210-610-0475
Mailing Address - Fax:210-610-8671
Practice Address - Street 1:5107 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-614-8612
Practice Address - Fax:210-615-5596
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX749278363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily