MEDICARE: KIMBERLY DONNELLY

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	363L00000X	Nurse Practitioner	2016041687	MO
2	363LF0000X	Family Nurse Practitioner	2016041687	MO

General Provider Information

NPI Number	:	1851750988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY DONNELLY

Provider Business Mailing Address
First Line	:	315 W 75TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-5738
Country	:	US
Telephone Number	:	866-389-2727
Fax Number	:

Provider Business Practice Location Address
First Line	:	4990 NE VIVION RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-2935
Country	:	US
Telephone Number	:	866-389-2727
Fax Number	:

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

Provider Enumeration Date	:	02/17/2016
Last Update Date	:	09/18/2024

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Directions to “ KIMBERLY DONNELLY ” Practice Location

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