Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | AP116494 | TX |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 693590 | TX |
N | 363LP0200X | Nurse Practitioner - Pediatrics | 693590 | TX |
N | 363LP2300X | Nurse Practitioner - Primary Care | 693590 | TX |
NPI | 1235313602 |
---|---|
Provider Name | Mrs. Kimberly Katheryne Miklis |
First Address | Allen, TX 75013-5361 |
Second Address | Dallas, TX 75246-2017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2007 |
Last Update Date | 16/12/2016 |