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NPI Code Detail

MEDICARE: KIMBERLY J DIERKS P.A.-C

MEDICARE: KIMBERLY J DIERKS P.A.-C
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
1363A00000XPhysician Assistant001733IA
2363A00000XPhysician Assistant1108NE

General Provider Information

NPI Number : 1750374666
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY J DIERKS P.A.-C
Provider Business Mailing Address
First Line : 988102 NEBRASKA MEDICAL CTR
Second Line :
City : OMAHA
State : NE
Zip : 68198-8102
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 139 S 40TH ST
Second Line :
City : OMAHA
State : NE
Zip : 68131-3003
Country : US
Telephone Number : 402-595-3939
Fax Number : 402-595-3898
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2005
Last Update Date : 08/17/2017

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Directions to “ KIMBERLY J DIERKS P.A.-C” Practice Location

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