Healthcare Provider Details

I. General information

NPI: 1912613928
Provider Name (Legal Business Name): KIMBERLEY ENSOR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 E 19TH AVE
WINFIELD KS
67156-5201
US

IV. Provider business mailing address

918 N BEAU JARDIN ST
DERBY KS
67037-7311
US

V. Phone/Fax

Practice location:
  • Phone: 620-221-9500
  • Fax:
Mailing address:
  • Phone: 316-759-9492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5381881021
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: