Provider Demographics
NPI:1164753786
Name:KIMBER, AMY N (NP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:N
Last Name:KIMBER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:N
Other - Last Name:HIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DIVISION OF PULMONARY DISEASE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-955-7040
Mailing Address - Fax:414-955-6211
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DIVISION OF PULMONARY DISEASE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-955-7040
Practice Address - Fax:414-955-6211
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI150976363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1164753786Medicaid
WI1164753786Medicaid