Healthcare Provider Details

I. General information

NPI: 1780825570
Provider Name (Legal Business Name): KIMBERLY A BERTHOLD RN, BC, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY A. GROSS RN, BC, FNP

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 05/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 NE SAINT LUKES BLVD SUITE 240
LEES SUMMIT MO
64086-6001
US

IV. Provider business mailing address

4330 WORNALL RD SUITE 2000
KANSAS CITY MO
64111-5939
US

V. Phone/Fax

Practice location:
  • Phone: 816-931-1883
  • Fax: 816-756-3645
Mailing address:
  • Phone: 816-931-1883
  • Fax: 816-756-3645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2008001025
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: