Most Relevant Information
Provider Data
| NPI Number: | 1003396391 |
| Provider Name: | KIMBERLY BRIDZEKE STATON APRN |
| Entity Type: | Individual |
| Taxonomy Code: | 363LP0808X |
| Specialty: | Nurse Practitioner |
| License Number: | AP138337 |
Most Important Dates
| Enumeration Date: | 08/16/2018 |
| Last Updated: | 08/16/2018 |
Provider Practice Location
1201 E 7TH ST STE 620
AUSTIN
TX
787023222
Practice Location Phone/Fax
| Phone: | 8003703651 |
| Fax: | 8775157147 |
Provider Mailing Location
55 HATCHETTS HILL RD
OLD LYME
CT
063711534
Provider Mailing Phone/Fax
| Phone: | 8003703651 |
| Fax: | 8775157147 |