Provider Demographics
NPI:1144825027
Name:CHEN, KIMBERLY MAE (FNP-C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MAE
Last Name:CHEN
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 1:1730 E HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4404
Mailing Address - Country:US
Mailing Address - Phone:832-952-3177
Mailing Address - Fax:346-358-8460
Practice Address - Street 1:302 CLEAR CREEK AVE
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3818
Practice Address - Country:US
Practice Address - Phone:281-910-2261
Practice Address - Fax:346-358-8460
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000550363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX22344353OtherNCSBN