MEDICARE: KIMBERLY KENNEY RN BSN

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	163WH0200X	Home Health Registered Nurse	115642	IA

General Provider Information

NPI Number	:	1518560994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY KENNEY RN BSN

Provider Business Mailing Address
First Line	:	4019 ADAMS ST
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51108-1416
Country	:	US
Telephone Number	:	712-212-1777
Fax Number	:

Provider Business Practice Location Address
First Line	:	4019 ADAMS ST
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51108-1416
Country	:	US
Telephone Number	:	712-212-1777
Fax Number	:

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

Provider Enumeration Date	:	11/18/2020
Last Update Date	:	11/18/2020

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