Provider Demographics
NPI:1336327055
Name:KEMNITZER, KIMBERLY ANN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:KEMNITZER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:GRAUF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1415 W SCENIC RIVERS BLVD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MO
Mailing Address - Zip Code:65560-2840
Mailing Address - Country:US
Mailing Address - Phone:573-729-5533
Mailing Address - Fax:573-202-2466
Practice Address - Street 1:1415 W SCENIC RIVERS BLVD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MO
Practice Address - Zip Code:65560-2840
Practice Address - Country:US
Practice Address - Phone:573-729-5533
Practice Address - Fax:573-202-2466
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004019274363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2004019274Medicaid
MO26D0679044OtherCLIA
MO1306885587Medicaid
MO1447412770Medicaid
MO26D0889777OtherCLIA
MO1235178930Medicaid
MO1710004486Medicaid
MO2004019274Medicaid
MO268630Medicare Oscar/Certification