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NPI Code Detail

MEDICARE: MS. KIMBERLY LEAH COLLYMORE FNP

MEDICARE: MS. KIMBERLY LEAH COLLYMORE FNP
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
1363LF0000XFamily Nurse Practitioner13264-33WI

General Provider Information

NPI Number : 1912110305
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KIMBERLY LEAH COLLYMORE FNP
Provider Business Mailing Address
First Line : 2403 FOLSOM ST
Second Line :
City : EAU CLAIRE
State : WI
Zip : 54703-2435
Country : US
Telephone Number : 715-552-9784
Fax Number : 715-835-6370
Provider Business Practice Location Address
First Line : 2900 S WISCONSIN AVE
Second Line :
City : RICE LAKE
State : WI
Zip : 54868-8578
Country : US
Telephone Number : 715-997-3915
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2007
Last Update Date : 04/10/2026

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