Healthcare Provider Details

I. General information

NPI: 1982283438
Provider Name (Legal Business Name): KIMBERLY WARREN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8495 CRATER LAKE HWY
WHITE CITY OR
97503-3011
US

IV. Provider business mailing address

2225 NORTH EL DORADO AVE
KLAMATH FALLS OR
97601
US

V. Phone/Fax

Practice location:
  • Phone: 541-830-7440
  • Fax:
Mailing address:
  • Phone: 541-830-7440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1033843
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: