Provider Demographics
NPI:1255317160
Name:CASE, KIMBERLY FAYE (MS CNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:FAYE
Last Name:CASE
Suffix:
Gender:F
Credentials:MS CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1111 DUFF AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-5745
Mailing Address - Country:US
Mailing Address - Phone:515-956-2880
Mailing Address - Fax:515-956-2879
Practice Address - Street 1:1111 DUFF AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-5745
Practice Address - Country:US
Practice Address - Phone:515-956-2880
Practice Address - Fax:515-956-2879
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2723363L00000X
MNR143364-7363L00000X
IA108760363L00000X
IAA154471363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00221351OtherMEDICARE RAILROAD
MNQ32420Medicare UPIN