Individual provider Active NPI

Kimberly Brown, FNP

  • Nurse Practitioner
  • Tyler, TX
National Provider Identifier
1083084537
Registry record updated Mar 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP129129 Issued in TX
Practice address
912 S Fleishel Ave
Tyler, TX 75701-2018
Phone
(903) 592-6901
Fax
(903) 592-9986
NPI assigned
Sep 28, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP129129 TX Primary

Addresses

Primary practice location

912 S Fleishel Ave
Tyler, TX 75701-2018

Mailing address

912 S Fleishel Ave
Tyler, TX 75701-2018
Phone (903) 592-6901

Other practice location 1

11937 US Highway 271
Tyler, TX 75708-3154
Phone (903) 877-7777

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151106000377 TX Practitioner - Nurse Practitioner 5496065260 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Etmc Physician Group, Inc.Group PAC ID 4486915600, 375 clinicians

Practice addresses (Care Compare)

117 N Winnsboro St
Quitman, TX 75783-2144
Phone (903) 763-6220

18118 FM 344
Flint, TX 75762-6010
Phone (903) 825-3292

2701 US Hwy 271 N
Pittsburg, TX 75686-4289
Phone (903) 946-5442

300 Wilson St
Henderson, TX 75652-5956
Phone (903) 655-6536

409 Cottage Rd
Carthage, TX 75633-1466
Phone (903) 694-4790

709 E Goode St
Quitman, TX 75783-1623

912 S Fleishel Ave
Tyler, TX 75701-2018
Phone (903) 592-6901

Hospital & facility affiliations

  • Ut Health East Texas Tyler Regional Hospital Hospital, Tyler, TX, CCN 450083
  • Ut Health East Texas Henderson Hospital Hospital, Henderson, TX, CCN 450475
  • Ut Health East Texas Carthage Hospital Hospital, Carthage, TX, CCN 450210
  • Christus Mother Frances Hospital Hospital, Tyler, TX, CCN 450102
  • Ut Health East Texas Quitman Hospital Hospital, Quitman, TX, CCN 451380
  • Ut Health East Texas Rehabilitation Hospital Inpatient rehabilitation facility, Tyler, TX, CCN 453072

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
AP129129TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Etmc Physician Group Inc. CurrentSince May 1, 2019 Accepting new patients
Etmc Physician Group Inc. CurrentSince May 1, 2019 Accepting new patients

Locations

18118 FM 344 W
Flint, TX 75762
Phone (903) 825-3292

300 Wilson St
Henderson, TX 75652
Phone (903) 655-6536

11937 US Highway 271
Tyler, TX 75708
Phone (903) 877-3451

1000 S Beckham Ave
Tyler, TX 75701
Phone (903) 526-1068

912 S Fleishel Ave
Tyler, TX 75701
Phone 90359269011811

Interoperability endpoints

  • Direct secure messaging: kbrown@psotmd.gwaydirect.com
  • Direct secure messaging: kbrown354970@ahs.direct-ci.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1443398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522022400000",
    "number": "1083084537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "912 S FLEISHEL AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012018",
            "telephone_number": "903-592-6901",
            "fax_number": "903-592-9986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 S FLEISHEL AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012018",
            "telephone_number": "903-592-6901",
            "fax_number": "903-592-9986"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11937 US Highway 271",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757083154",
            "country_code": "US",
            "telephone_number": "903-877-7777",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROWN",
        "first_name": "KIMBERLY",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-28",
        "last_updated": "2018-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP129129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.