Provider Demographics
NPI:1124774500
Name:KIMBLE, IESHIA (PMHNP)
Entity type:Individual
Prefix:
First Name:IESHIA
Middle Name:
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6114 GULLY GROVE DR
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-3161
Mailing Address - Country:US
Mailing Address - Phone:414-520-7156
Mailing Address - Fax:469-589-4976
Practice Address - Street 1:1005 W RALPH HALL PKWY
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6658
Practice Address - Country:US
Practice Address - Phone:469-545-0160
Practice Address - Fax:469-589-4976
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-24
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1071306363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health