Provider Demographics
NPI:1114139425
Name:HEIM, KIMBERLY KAYE (NP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:KAYE
Last Name:HEIM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 MEMORIAL SQ STE 50
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-1357
Mailing Address - Country:US
Mailing Address - Phone:317-462-6270
Mailing Address - Fax:317-468-6268
Practice Address - Street 1:300 E BOYD AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-2834
Practice Address - Country:US
Practice Address - Phone:317-462-1992
Practice Address - Fax:317-467-6694
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000832A174400000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No174400000XOther Service ProvidersSpecialist