Provider Demographics
NPI:1154545291
Name:MEIXNER, KIMBERLY S (FNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:MEIXNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:3410 WORTH ST
Practice Address - Street 2:MEDICAL STAFF SERVICES
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2006
Practice Address - Country:US
Practice Address - Phone:214-370-1300
Practice Address - Fax:214-370-1313
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX653467363LF0000X
TXAP113044363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196879403Medicaid
TX196879404Medicaid
TX196879408Medicaid
TX196879406Medicaid
TX196879410Medicaid
TX8Y1767OtherBLUE CROSS BLUE SHIELD
TX196879405Medicaid
TX196879407Medicaid
TX196879412Medicaid
TX196879401Medicaid
TX196879402Medicaid
TXP01898982OtherRAILROAD
TX196879411Medicaid
TX196879409Medicaid
TX196879407Medicaid
TX196879403Medicaid