MEDICARE: MRS. KIMBERLEY A OLIPHANT ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	LG0000328	DE
2	363LF0000X	Family Nurse Practitioner	ARNP9397535	FL

General Provider Information

NPI Number	:	1255444683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLEY A OLIPHANT ARNP

Provider Business Mailing Address
First Line	:	P.O. BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-424-1449
Fax Number	:	239-424-1421

Provider Business Practice Location Address
First Line	:	1435 S.E. 8TH TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3289
Country	:	US
Telephone Number	:	239-424-2757
Fax Number	:	239-772-0186

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	10/26/2015

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