Provider Demographics
NPI:1528067501
Name:ROULEAU, KIMBERLY ANNE (ARNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE
Last Name:ROULEAU
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANNE
Other - Last Name:ROULEAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:706 RIVERWAY PL
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6768
Mailing Address - Country:US
Mailing Address - Phone:603-623-3516
Mailing Address - Fax:603-623-3580
Practice Address - Street 1:706 RIVERWAY PL
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6768
Practice Address - Country:US
Practice Address - Phone:603-623-3516
Practice Address - Fax:603-623-3580
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH041762-23-05363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30011686Medicaid
NHRONH1361OtherHARVARD PILGRIM
NH4000801Y0NH01OtherANTHEM
NH4522244OtherCIGNA
NH4522244OtherCIGNA
NH30011686Medicaid