=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548728132
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY RANEE SUMNER-BROOKS APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2019
-----------------------------------------------------
Last Update Date | 03/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3370 BURNS RD STE 102
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33410-4327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-799-5417
-----------------------------------------------------
Fax | 561-799-5427
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6329 CRESCENT LAKE WAY
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33463-7922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-385-0714
-----------------------------------------------------
Fax | 561-799-5427
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | APRN3073512
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------