Healthcare Provider Details

I. General information

NPI: 1982171625
Provider Name (Legal Business Name): KIMBERLY DOOLIN RN, BSN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2018
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N OAKLAND AVE
BOLIVAR MO
65613-3011
US

IV. Provider business mailing address

165 DURNELL ST
OSCEOLA MO
64776-9564
US

V. Phone/Fax

Practice location:
  • Phone: 417-328-6305
  • Fax:
Mailing address:
  • Phone: 417-448-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number2013003961
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2019002365
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: