Provider Demographics
NPI:1538878863
Name:RUIZ, KIMBERLY P (PLMHP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:P
Last Name:RUIZ
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5858
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-5858
Mailing Address - Country:US
Mailing Address - Phone:308-381-7487
Mailing Address - Fax:308-381-2712
Practice Address - Street 1:3532 W CAPITAL AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1205
Practice Address - Country:US
Practice Address - Phone:308-381-7487
Practice Address - Fax:308-381-2712
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12025101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health