Provider Demographics
NPI:1003007477
Name:ABDOW, KIMBERLY BETH (NP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:BETH
Last Name:ABDOW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2265
Mailing Address - Country:US
Mailing Address - Phone:508-753-5554
Mailing Address - Fax:
Practice Address - Street 1:435 SHREWSBURY ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2265
Practice Address - Country:US
Practice Address - Phone:508-753-5554
Practice Address - Fax:508-752-7245
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA206917364SF0001X
MARN206918163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health