Provider Demographics
NPI:1972591626
Name:WEBER, KIM M (CRNA)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:M
Last Name:WEBER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:KIM
Other - Middle Name:M
Other - Last Name:MANNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-0938
Mailing Address - Country:US
Mailing Address - Phone:254-634-6999
Mailing Address - Fax:254-200-4090
Practice Address - Street 1:2201 S CLEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4110
Practice Address - Country:US
Practice Address - Phone:254-526-7523
Practice Address - Fax:254-200-4090
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235847367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00C40TOtherBLUE CROSS BLUE SHIELD
TX00C40TOtherBLUE CROSS BLUE SHIELD