Provider Demographics
NPI:1093409799
Name:ZIMBARDO, KYLEE ANN (CNP)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:ANN
Last Name:ZIMBARDO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KYLEE
Other - Middle Name:ANN
Other - Last Name:ZIMBARDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:3518 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-2211
Mailing Address - Country:US
Mailing Address - Phone:605-484-5467
Mailing Address - Fax:
Practice Address - Street 1:3200 CANYON LAKE DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8114
Practice Address - Country:US
Practice Address - Phone:605-355-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR049952163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse