Kimberlee Mack, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA11188 Issued in TX

Practice address

590 Medical Center Road
Fort Cavazos, TX 76544

Phone

(915) 591-2704

Fax

(915) 225-0413

NPI assigned

Feb 21, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Salud Y Vida, P.a.

  • Family Medicine Physician
  • El Paso, TX
  • NPI 1043287287
  Medicare reassignment
• Diagnostic Pro Imaging

  • Diagnostic Radiology Physician
  • El Paso, TX
  • NPI 1346777190

  Multi-Specialty

  NPD (past)

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

{
    "created_epoch": "1487635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784851200000",
    "number": "1396284592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36000 DARNALL LOOP",
            "city": "FORT HOOD",
            "state": "TX",
            "postal_code": "765445095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 MEDICAL CENTER ROAD",
            "city": "FORT CAVAZOS",
            "state": "TX",
            "postal_code": "76544",
            "telephone_number": "915-591-2704",
            "fax_number": "915-225-0413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "KIMBERLEE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-02-21",
        "last_updated": "2026-07-24",
        "certification_date": "2026-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA11188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandon Da'Juan Lucas, DNP, APRN, PMHNP-BC
• Tyler J Lucas, PT, DPT
• Kristin Rose Luciano, RDH
• Danika Lund, DDS
• Allen Lutz
• Mark Field Mackey, CRNA
• Peter Michael Maese, APRN-FNP
• Jennifer Anne Malashevitz, PA-C
• Eric Malmin
• Joseph Marotto, MD

• Physician Assistant in Fort Cavazos, TX
• Providers in Fort Cavazos, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.