Provider Demographics
NPI:1285917575
Name:NUNEZ, KIM G (ANP)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:G
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 EULE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-9504
Mailing Address - Country:US
Mailing Address - Phone:832-545-5658
Mailing Address - Fax:
Practice Address - Street 1:5110 EULE DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-9504
Practice Address - Country:US
Practice Address - Phone:832-545-5658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX716275363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8220NCOtherBCBS
TX2968828-02Medicaid
TX8220NCOtherBCBS