Provider Demographics
NPI:1043777147
Name:UMANSKY, KIMBERLY A (NP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:UMANSKY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:UMANSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KIMBERLY ANN CARTY
Mailing Address - Street 1:650 COUNTRY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-2036
Mailing Address - Country:US
Mailing Address - Phone:619-437-6292
Mailing Address - Fax:
Practice Address - Street 1:1751 E GARRY AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5814
Practice Address - Country:US
Practice Address - Phone:877-896-7350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95009243363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily