Provider Demographics
NPI:1437151727
Name:TALBOT, KIMBERLY L (ARNP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:L
Last Name:TALBOT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 N RIDGE RD STE 240
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1138
Mailing Address - Country:US
Mailing Address - Phone:316-838-7700
Mailing Address - Fax:316-838-8770
Practice Address - Street 1:2260 N RIDGE RD STE 240
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1138
Practice Address - Country:US
Practice Address - Phone:316-838-7700
Practice Address - Fax:316-838-8770
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74374364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSQ42783Medicare UPIN
KS161479Medicare ID - Type Unspecified