Kimberly Tanis Russell, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

N0422 Issued in TX

Practice address

36065 Sante Fe Ave
Fort Cavazos, TX 76544-5044

Phone

(254) 288-8932

NPI assigned

Jan 17, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Primary Health Network

  • Federally Qualified Health Center (FQHC)
  • Emlenton, PA
  • NPI 1750181038
  NPD (past)
• Upper Chesapeake Primary Care,LLC

  • Internal Medicine Physician
  • Bel Air, MD
  • NPI 1093902793
  NPD (past)

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1720130305",
    "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": "36065 SANTE FE AVE",
            "city": "FORT CAVAZOS",
            "state": "TX",
            "postal_code": "765445044",
            "telephone_number": "254-288-8932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "KIMBERLY",
        "middle_name": "TANIS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-17",
        "last_updated": "2026-07-13",
        "certification_date": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "N0422",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD069021L",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sergio Romero
• David Rosario, PSY.D.
• Alexis Marie Ruber, DMD
• Jacqueline Ruiz-Lugo, LCSW
• Patrick Rushford, MD
• Brittany Ryan
• Juan Carlos Saavedra, M.D.
• Erisa Sablan
• Bernadette Espeleta Sakai, PSY.D.
• Ruben Salinas Jr., MD

• Family Medicine Physician in Fort Cavazos, TX
• Providers in Fort Cavazos, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.