Provider Demographics
NPI:1083206742
Name:VILT, KIMBERLY RAE (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RAE
Last Name:VILT
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 NEWBURG RD STE 210
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-2458
Mailing Address - Country:US
Mailing Address - Phone:502-454-8800
Mailing Address - Fax:
Practice Address - Street 1:3430 NEWBURG RD STE 210
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-2458
Practice Address - Country:US
Practice Address - Phone:502-454-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015815363LP0808X
KY1130985163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health