Provider Demographics
NPI:1033643796
Name:PENNY, KIMBERLEE (RN)
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:
Last Name:PENNY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4980 S 118TH ST
Mailing Address - Street 2:MOSAIC
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2200
Mailing Address - Country:US
Mailing Address - Phone:402-896-3884
Mailing Address - Fax:402-896-8751
Practice Address - Street 1:302 WEST AVENUE
Practice Address - Street 2:SOUTH CENTRAL NEBRASKA AGENCY
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-0496
Practice Address - Country:US
Practice Address - Phone:308-995-8652
Practice Address - Fax:308-995-5226
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE69175163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse