Healthcare Provider Details

I. General information

NPI: 1255477113
Provider Name (Legal Business Name): KIMBERLY ANN BEHNKE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E CARPENTER ST STE 1A
SPRINGFIELD IL
62702-5165
US

IV. Provider business mailing address

6328 BRENT DR
SPRINGFIELD IL
62712-7510
US

V. Phone/Fax

Practice location:
  • Phone: 217-523-0808
  • Fax: 217-523-9859
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: