1336327055 NPI number — MRS. KIMBERLY ANN KEMNITZER FNP-C

Table of content: MRS. KIMBERLY ANN KEMNITZER FNP-C (NPI 1336327055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336327055 NPI number — MRS. KIMBERLY ANN KEMNITZER FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEMNITZER
Provider First Name:
KIMBERLY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRAUF
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
ANN
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:
1336327055
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
216 W 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65560-1336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-453-5070
Provider Business Mailing Address Fax Number:
573-340-6086

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
216 W 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65560-1336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-453-5070
Provider Business Practice Location Address Fax Number:
573-340-6086
Provider Enumeration Date:
02/05/2008

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: 363LF0000X , with the licence number:  2004019274 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 26D0679044 . This is a "CLIA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1235178930 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1306885587 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2004019274 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26D0889777 . This is a "CLIA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1447412770 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1710004486 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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