Provider Demographics
NPI:1376259184
Name:WHITING, KIMBERLY MICHELE (RN)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MICHELE
Last Name:WHITING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:MICHELE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1801 N SENATE BLVD STE 635
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1212
Mailing Address - Country:US
Mailing Address - Phone:317-944-3636
Mailing Address - Fax:317-968-1371
Practice Address - Street 1:1801 N SENATE BLVD STE 635
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1212
Practice Address - Country:US
Practice Address - Phone:317-944-3636
Practice Address - Fax:317-968-1371
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28236535A163W00000X, 163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery
No163W00000XNursing Service ProvidersRegistered Nurse