Provider Demographics
NPI:1164681862
Name:WEATHERSPOON, KIMBERLY CHARMELL (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CHARMELL
Last Name:WEATHERSPOON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2190 NORTH LOOP W STE 250
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-8016
Mailing Address - Country:US
Mailing Address - Phone:281-231-9667
Mailing Address - Fax:
Practice Address - Street 1:2190 NORTH LOOP W STE 250
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-8016
Practice Address - Country:US
Practice Address - Phone:281-231-9667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD716132085R0202X
TXS21982085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology