Provider Demographics
NPI:1538571310
Name:PARK, KIMBERLY (LPN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSMOUTH
Mailing Address - State:NE
Mailing Address - Zip Code:68048-2429
Mailing Address - Country:US
Mailing Address - Phone:402-296-3245
Mailing Address - Fax:
Practice Address - Street 1:120 JAMES ST
Practice Address - Street 2:
Practice Address - City:PLATTSMOUTH
Practice Address - State:NE
Practice Address - Zip Code:68048-2429
Practice Address - Country:US
Practice Address - Phone:402-296-3245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13403164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse