Provider Demographics
NPI:1982946836
Name:WALDRIP, KIMBERLY BETH (APN)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:BETH
Last Name:WALDRIP
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MRS
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:WALDRIP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:PO BOX 751
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:TX
Mailing Address - Zip Code:77836-0751
Mailing Address - Country:US
Mailing Address - Phone:979-324-3209
Mailing Address - Fax:
Practice Address - Street 1:919 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BROWNFIELD
Practice Address - State:TX
Practice Address - Zip Code:79316-4633
Practice Address - Country:US
Practice Address - Phone:806-637-2164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX590167363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily