Provider Demographics
NPI:1245558600
Name:CROMP, KIMBERLY B
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:B
Last Name:CROMP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:B
Other - Last Name:SCHENKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8857
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46898-8857
Mailing Address - Country:US
Mailing Address - Phone:260-969-6200
Mailing Address - Fax:260-969-6201
Practice Address - Street 1:7333 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6280
Practice Address - Country:US
Practice Address - Phone:260-435-7334
Practice Address - Fax:260-435-7748
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003327A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health