1487823175 NPI number — MS. ERIKA NICOLE KIMBLE RN, BSN, MA, MS, NP

Table of content: MS. ERIKA NICOLE KIMBLE RN, BSN, MA, MS, NP (NPI 1487823175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487823175 NPI number — MS. ERIKA NICOLE KIMBLE RN, BSN, MA, MS, NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIMBLE
Provider First Name:
ERIKA
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN, BSN, MA, MS, NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MERRITT
Provider Other First Name:
ERIKA
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487823175
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11035 LAVENDER HILL DR STE 160-326
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89135-2955
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-670-2048
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 N TENAYA WAY STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89128-1100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-202-2700
Provider Business Practice Location Address Fax Number:
702-307-5480
Provider Enumeration Date:
02/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  APRN001610 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 09894 . This is a "ARNP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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