Provider Demographics
NPI:1043223365
Name:KIMBALL, DIANE R (APRN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:R
Last Name:KIMBALL
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 1:6725 SW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-5625
Mailing Address - Country:US
Mailing Address - Phone:785-354-0517
Mailing Address - Fax:
Practice Address - Street 1:6725 SW 29TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-5625
Practice Address - Country:US
Practice Address - Phone:785-354-0517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45078363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100371200AMedicaid
160492Medicare ID - Type Unspecified