1902179195 NPI number — KIMBERLY ANN BARNHILL ARNP

Table of content: KIMBERLY ANN BARNHILL ARNP (NPI 1902179195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902179195 NPI number — KIMBERLY ANN BARNHILL ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARNHILL
Provider First Name:
KIMBERLY
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902179195
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4828 N DAVIS HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32503-2341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-477-8109
Provider Business Mailing Address Fax Number:
850-476-5313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4531 N DAVIS HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32503-2770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-436-4563
Provider Business Practice Location Address Fax Number:
850-436-4570
Provider Enumeration Date:
02/17/2012

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:  ARNP3059842 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004605900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: Y09XD . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 004605900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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