Basic Information
| Provider Information | |||||||||
| NPI: | 1861100182 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIMBROUGH | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | NEWTON | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSN, APRN, AGNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5939 HARRY HINES BOULEVARD | ||||||||
| Address2: | PROFESSIONAL OFFICE BUILDING 2, 7TH FLOOR, SUITE 700 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753909258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146451919 | ||||||||
| FaxNumber: | 2146451903 | ||||||||
| Practice Location | |||||||||
| Address1: | 5939 HARRY HINES BOULEVARD | ||||||||
| Address2: | PROFESSIONAL OFFICE BUILDING 2, 7TH FLOOR, SUITE 700 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753909258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146451919 | ||||||||
| FaxNumber: | 2146451903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2022 | ||||||||
| LastUpdateDate: | 11/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1056745 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.