Healthcare Provider Details

I. General information

NPI: 1205248093
Provider Name (Legal Business Name): KIMBERLY HILL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY WALTER PA-C

II. Dates (important events)

Enumeration Date: 05/28/2014
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4333 S 86TH ST STE 100
LINCOLN NE
68526-9261
US

IV. Provider business mailing address

4333 S 86TH ST STE 100
LINCOLN NE
68526-9261
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-8500
  • Fax: 402-483-8501
Mailing address:
  • Phone: 402-483-8500
  • Fax: 402-483-8501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1798
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: