Provider Demographics
NPI:1245898634
Name:LAM, KIMBERLY VAN (NP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:VAN
Last Name:LAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11951 LAUREL MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-8586
Mailing Address - Country:US
Mailing Address - Phone:832-341-1100
Mailing Address - Fax:
Practice Address - Street 1:455 SCHOOL ST STE 20
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4597
Practice Address - Country:US
Practice Address - Phone:812-357-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141470363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily