MEDICARE: KIMBERLY L BOOTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	51896	NE

General Provider Information

NPI Number	:	1841188745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY L BOOTH

Provider Business Mailing Address
First Line	:	1337 S 22ND ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68108-3414
Country	:	US
Telephone Number	:	402-249-8698
Fax Number	:

Provider Business Practice Location Address
First Line	:	1337 S 22ND ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68108-3414
Country	:	US
Telephone Number	:	402-249-8698
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2025
Last Update Date	:	06/27/2025

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Directions to “ KIMBERLY L BOOTH ” Practice Location

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