Provider Demographics
NPI:1073268488
Name:WEISS, KIMBERLY IRENE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:IRENE
Last Name:WEISS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 CENTER ST.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BISMARCK
Mailing Address - State:MO
Mailing Address - Zip Code:63624
Mailing Address - Country:US
Mailing Address - Phone:573-200-8030
Mailing Address - Fax:573-200-8033
Practice Address - Street 1:405 CENTER ST.
Practice Address - Street 2:SUITE 1
Practice Address - City:BISMARCK
Practice Address - State:MO
Practice Address - Zip Code:63624
Practice Address - Country:US
Practice Address - Phone:573-200-8030
Practice Address - Fax:573-200-8033
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022000394363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty