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General NPI Number Information
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NPI Number | 1396534871
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Entity Type | Individual
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Provider Name | KIMBERLY SUMMERS
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Gender | Female
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Dates
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Enumeration Date | 05/02/2025
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 121 S MAIN ST
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City | CARROLLTON
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State | IL
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Zip | 62016-1340
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Country | US
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Telephone | 217-939-0236
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Fax |
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Provider Business Mailing Address
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Address Line | 202 BRUCE DR
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City | WHITE HALL
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State | IL
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Zip | 62092-1178
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Country | US
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Telephone | 217-939-1307
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 043078572
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License Number State | IL
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