Provider Demographics
NPI:1578369948
Name:KIMBROUGH, KARSYN DANIELLE (PA)
Entity type:Individual
Prefix:
First Name:KARSYN
Middle Name:DANIELLE
Last Name:KIMBROUGH
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 COUNTY ROAD 567
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-8762
Mailing Address - Country:US
Mailing Address - Phone:254-485-2271
Mailing Address - Fax:
Practice Address - Street 1:445 COUNTY ROAD 567
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-8762
Practice Address - Country:US
Practice Address - Phone:254-485-2271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA18773363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant