Provider Demographics
NPI:1235586496
Name:ERICKSON, KIMBERLY JO (CNM, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JO
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:CNM, WHNP-BC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:JO
Other - Last Name:BERTRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, WHNP-BC
Mailing Address - Street 1:5124 CENTRAL PARK PL
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-9317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1313 FISH HATCHERY RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1911
Practice Address - Country:US
Practice Address - Phone:608-252-8000
Practice Address - Fax:608-283-7354
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI148946-32367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife