Provider Demographics
NPI:1275616492
Name:ALLEN, KIMBERLY K (DO)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:K
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1066
Mailing Address - Street 2:4508 38TH STREET SUITE 165
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68602
Mailing Address - Country:US
Mailing Address - Phone:402-564-7200
Mailing Address - Fax:402-564-7210
Practice Address - Street 1:3775 45TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-4427
Practice Address - Country:US
Practice Address - Phone:402-564-7200
Practice Address - Fax:402-564-7210
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE155208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025279800Medicaid
NE10025279800Medicaid
NE279273Medicare ID - Type Unspecified