Provider Demographics
NPI:1083371470
Name:LIBERTY, KIMBERLY R (APRN)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:R
Last Name:LIBERTY
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 1:40 STILL RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON
Mailing Address - State:VT
Mailing Address - Zip Code:05656-9182
Mailing Address - Country:US
Mailing Address - Phone:802-598-4531
Mailing Address - Fax:
Practice Address - Street 1:3 CREST RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-9753
Practice Address - Country:US
Practice Address - Phone:802-524-4554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-20
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0135116363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily