Healthcare Provider Details

I. General information

NPI: 1801953740
Provider Name (Legal Business Name): KIMBERLY M. KILGORE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S 70TH ST SUITE 225
LINCOLN NE
68510-7906
US

IV. Provider business mailing address

7441 O ST STE 402
LINCOLN NE
68510-2466
US

V. Phone/Fax

Practice location:
  • Phone: 402-416-4152
  • Fax:
Mailing address:
  • Phone: 402-483-4215
  • Fax: 844-537-3574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number697
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: