Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP118333 | TX |
N | 363LA2100X | Nurse Practitioner - Acute Care | 707989 | TX |
NPI | 1003042573 |
---|---|
Provider Name | Mrs. Kimberly Anne Lucas Slimane |
First Address | San Antonio, TX 78240-1671 |
Second Address | San Antonio, TX 78240-1671 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2009 |
Last Update Date | 29/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
296559201 | (05) | TX |