Provider Demographics
NPI:1164250841
Name:BLUMENBERG, KIMBERLY RENEE (WHNP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:RENEE
Last Name:BLUMENBERG
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:211 TERRY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:TERRY
Mailing Address - State:MS
Mailing Address - Zip Code:39170-5504
Mailing Address - Country:US
Mailing Address - Phone:601-750-8513
Mailing Address - Fax:
Practice Address - Street 1:3794 HIGHWAY 468 W
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-9008
Practice Address - Country:US
Practice Address - Phone:601-932-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904661363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health