Provider Demographics
NPI:1871774117
Name:GONZALEZ, KIMBERLY ANN (PA-C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:GONZALEZ
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 S MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8278
Mailing Address - Country:US
Mailing Address - Phone:956-683-7900
Mailing Address - Fax:956-683-9910
Practice Address - Street 1:5115 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8278
Practice Address - Country:US
Practice Address - Phone:956-683-7900
Practice Address - Fax:956-683-9910
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05418363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192342701Medicaid
TXPA05418OtherSTATE LICENSE NUMBER