Provider Demographics
NPI:1417574278
Name:JUSTICE, KIMBERLY ANN (APRN, MSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:APRN, MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 W I 40 STE 180
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2522
Mailing Address - Country:US
Mailing Address - Phone:806-738-3456
Mailing Address - Fax:806-214-3417
Practice Address - Street 1:6900 W I 40 STE 180
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2522
Practice Address - Country:US
Practice Address - Phone:806-738-3456
Practice Address - Fax:806-214-3417
Is Sole Proprietor?:No
Enumeration Date:2020-06-28
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-80801163WP0808X
NM60947363LP0808X
TX1033630363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health