Healthcare Provider Details

I. General information

NPI: 1174114573
Provider Name (Legal Business Name): REBEKAH JOY KIMBERLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BEKAH JOY MALLETT

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 H ST
FAIRBURY NE
68352-1119
US

IV. Provider business mailing address

2200 H ST
FAIRBURY NE
68352-1119
US

V. Phone/Fax

Practice location:
  • Phone: 402-729-3351
  • Fax: 402-729-6880
Mailing address:
  • Phone: 402-729-3351
  • Fax: 402-729-6880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15348
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: