Healthcare Provider Details

I. General information

NPI: 1184957060
Provider Name (Legal Business Name): KIMBERLY ANN WELLS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY ANN BURROW APRN

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MERRITT DR STE 100
HENDERSON KY
42420-2788
US

IV. Provider business mailing address

2000 N ELM ST SUITE 1 B
HENDERSON KY
42420-2385
US

V. Phone/Fax

Practice location:
  • Phone: 270-827-0064
  • Fax: 270-826-3338
Mailing address:
  • Phone: 270-844-8144
  • Fax: 270-844-8145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3006176
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number3006176
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3006176
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: