Provider Demographics
NPI:1679538151
Name:WHITE, KIMBERLY S (APRN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:WHITE
Suffix:
Gender:F
Credentials:APRN
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 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:7430 JEFFERSON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-6159
Practice Address - Country:US
Practice Address - Phone:502-966-8675
Practice Address - Fax:502-966-8836
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002844363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000375696OtherANTHEM - NMA
KY50008061OtherPASSPORT & PASSPORT ADVANTAGE - NMA
KY78015229Medicaid
KY000023025MOtherHUMANA - NMA
KY064259OtherSIHO - NMA
KY000000375696OtherANTHEM - NMA
KY000023025MOtherHUMANA - NMA
KY50008061OtherPASSPORT & PASSPORT ADVANTAGE - NMA