Provider Demographics
NPI:1689565939
Name:COFFEE, KIMBERLY (AGPCNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:COFFEE
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 QUAILS PATH
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-7512
Mailing Address - Country:US
Mailing Address - Phone:817-915-8232
Mailing Address - Fax:
Practice Address - Street 1:5800 QUAILS PATH
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-7512
Practice Address - Country:US
Practice Address - Phone:817-915-8232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1203025363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health