Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 22689 | TX |
Y | 103T00000X | Psychologist | 22689 | TX |
NPI | 1013010206 |
---|---|
Provider Name | Dr. Frances Harriett Kimbrough |
First Address | Bryan, TX 77803 |
Second Address | Bryan, TX 77803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
QH92 | BLUE CROSS BLUE SHIELD (01) | TX |