Healthcare Provider Details

I. General information

NPI: 1558757237
Provider Name (Legal Business Name): KIMBERLY S CASTOR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY S KOWALSKI

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 N 93RD ST
OMAHA NE
68134
US

IV. Provider business mailing address

818 5TH AVE STE 200
DES MOINES IA
50309-1307
US

V. Phone/Fax

Practice location:
  • Phone: 877-811-7526
  • Fax: 515-280-9525
Mailing address:
  • Phone: 877-811-7526
  • Fax: 515-280-9525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF139115
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number111742
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: