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General NPI Number Information
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NPI Number | 1760262026
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Entity Type | Individual
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Provider Name | COURTNEY AMBER KIMACK
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Gender | Female
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Dates
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Enumeration Date | 10/04/2023
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 4055 MONROEVILLE BLVD STE 300
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City | MONROEVILLE
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State | PA
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Zip | 15146-2522
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Country | US
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Telephone | 724-299-8954
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Fax |
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Provider Business Mailing Address
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Address Line | 680 SARA LN
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City | VERONA
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State | PA
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Zip | 15147-2635
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Country | US
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Telephone |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | SP028401
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN683749
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License Number State | PA
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