Healthcare Provider Details

I. General information

NPI: 1992494330
Provider Name (Legal Business Name): SIDNEY ZIMMERMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 S MAIN ST
FORT SCOTT KS
66701-1413
US

IV. Provider business mailing address

4 S MAIN ST
FORT SCOTT KS
66701-1413
US

V. Phone/Fax

Practice location:
  • Phone: 620-498-5124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023024693
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTMP-161800
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13-138518021
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: