Provider Demographics
NPI:1346233970
Name:MEYER, KIMBERLY S (ARNP MSN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:MEYER
Suffix:
Gender:F
Credentials:ARNP MSN
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 909
Mailing Address - Street 2:SUITE 1105
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-0354
Mailing Address - Fax:502-588-0326
Practice Address - Street 1:220 ABRAHAM FLEXNER WAY # 1200
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3826
Practice Address - Country:US
Practice Address - Phone:502-899-3623
Practice Address - Fax:502-899-7970
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3581P364SN0800X
KY3003581363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No364SN0800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistNeuroscience
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200359610Medicaid
KY0288512Medicare ID - Type Unspecified
P47736Medicare UPIN