Healthcare Provider Details

I. General information

NPI: 1427012277
Provider Name (Legal Business Name): SUSAN J KIMBLE R.N., C.S., A.P.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 WESTWOODS DR
LIBERTY MO
64068-1181
US

IV. Provider business mailing address

140 WESTWOODS DR
LIBERTY MO
64068-1181
US

V. Phone/Fax

Practice location:
  • Phone: 816-781-4740
  • Fax: 816-781-0971
Mailing address:
  • Phone: 816-781-4740
  • Fax: 816-781-0971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number081949
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: