Healthcare Provider Details

I. General information

NPI: 1003745712
Provider Name (Legal Business Name): KIMBERLY J NALLY PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 S MAIDEN LN
JOPLIN MO
64801-3084
US

IV. Provider business mailing address

5510 COUNTY ROAD 200
JOPLIN MO
64801-6131
US

V. Phone/Fax

Practice location:
  • Phone: 417-782-6200
  • Fax: 417-782-6210
Mailing address:
  • Phone: 417-691-0161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2026020895
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: