Provider Demographics
NPI:1417081555
Name:BURR, KIMBERLEY SUE (CPC, LIMHP)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:SUE
Last Name:BURR
Suffix:
Gender:F
Credentials:CPC, LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 W 34TH STREET PL
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-4068
Mailing Address - Country:US
Mailing Address - Phone:308-233-5828
Mailing Address - Fax:
Practice Address - Street 1:4111 4TH AVE STE 32
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2884
Practice Address - Country:US
Practice Address - Phone:308-234-6029
Practice Address - Fax:308-237-4792
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2235101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47077781329Medicaid
NE47077781326Medicaid