Provider Demographics
NPI:1265507487
Name:OPPMAN, KIMBERLY K
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:OPPMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9143 INDIANAPOLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2500
Mailing Address - Country:US
Mailing Address - Phone:219-972-1547
Mailing Address - Fax:219-972-1641
Practice Address - Street 1:9143 INDIANAPOLIS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2500
Practice Address - Country:US
Practice Address - Phone:219-972-1547
Practice Address - Fax:219-972-1641
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006314363LF0000X
IN71001536A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201083410Medicaid
IN000000802045OtherANTHEM
IN000000802045OtherANTHEM