Provider Demographics
NPI:1053429761
Name:ANDREWS, KIMBERLY JEAN (CPNP-PC)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:JEAN
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:
Practice Address - Street 1:1965 S FREMONT
Practice Address - Street 2:STE 260
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2257
Practice Address - Country:US
Practice Address - Phone:417-820-0280
Practice Address - Fax:417-820-0290
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO152395363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01037293OtherMCR RR
MO431560263OtherTRICARE
MO1053429761Medicaid
AR192788758Medicaid
MO431560263OtherTRICARE