Provider Demographics
NPI:1851614226
Name:PRUESSNER, KIMIE MICHELLE (PA-C)
Entity type:Individual
Prefix:
First Name:KIMIE
Middle Name:MICHELLE
Last Name:PRUESSNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1050 N WESTMORELAND RD
Mailing Address - Street 2:#432
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-2444
Mailing Address - Country:US
Mailing Address - Phone:214-333-3033
Mailing Address - Fax:214-330-2163
Practice Address - Street 1:1050 N WESTMORELAND RD
Practice Address - Street 2:#432
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-2444
Practice Address - Country:US
Practice Address - Phone:214-333-3033
Practice Address - Fax:214-330-2163
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA06535363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant