Provider Demographics
NPI:1902487051
Name:MACNAUL, KIMBERLY ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:MACNAUL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13402 E SUMMERCHASE CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77318-5711
Mailing Address - Country:US
Mailing Address - Phone:832-948-8142
Mailing Address - Fax:
Practice Address - Street 1:601 RIVER POINTE DR STE 100
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2943
Practice Address - Country:US
Practice Address - Phone:936-446-2227
Practice Address - Fax:936-788-2221
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX794308163W00000X
TXF06212514363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse