Provider Demographics
NPI:1427012277
Name:KIMBLE, SUSAN J (RN, CS, APN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:J
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:RN, CS, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:140 WESTWOODS DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-1181
Mailing Address - Country:US
Mailing Address - Phone:816-781-4740
Mailing Address - Fax:816-781-0971
Practice Address - Street 1:140 WESTWOODS DR
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1181
Practice Address - Country:US
Practice Address - Phone:816-781-4740
Practice Address - Fax:816-781-0971
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO081949363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health