Healthcare Provider Details

I. General information

NPI: 1033586599
Provider Name (Legal Business Name): KIMBERLY R MEADE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY R RYDER

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 WILLOW ST
VINCENNES IN
47591-4276
US

IV. Provider business mailing address

2401 W MAIN ST
MARION IL
62959-1188
US

V. Phone/Fax

Practice location:
  • Phone: 812-882-0894
  • Fax:
Mailing address:
  • Phone: 618-969-2687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71005815A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28156992A
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: