Healthcare Provider Details

I. General information

NPI: 1992389894
Provider Name (Legal Business Name): KIMBERLY BRIANNE KOWAL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY BRIANNE NASON APRN

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 US HIGHWAY 41
SCHERERVILLE IN
46375-1317
US

IV. Provider business mailing address

1515 US HIGHWAY 41
SCHERERVILLE IN
46375-1317
US

V. Phone/Fax

Practice location:
  • Phone: 219-763-8112
  • Fax:
Mailing address:
  • Phone: 219-763-8112
  • Fax: 219-962-1792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number28209759A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28209759A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: