Healthcare Provider Details

I. General information

NPI: 1124062161
Provider Name (Legal Business Name): KIMBERLY KAY ANDERSON APRN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY K BAKER APRN, PMHNP

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11060 OAK ST STE 6
OMAHA NE
68144-4244
US

IV. Provider business mailing address

906 S 184TH ST
ELKHORN NE
68022-5756
US

V. Phone/Fax

Practice location:
  • Phone: 402-889-3633
  • Fax: 531-375-5196
Mailing address:
  • Phone: 402-889-3633
  • Fax: 531-375-5196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number110373
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: