Provider Demographics
NPI:1437586476
Name:MADDEN, KIMBERLY ANN (MSN, RN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:MADDEN
Suffix:
Gender:F
Credentials:MSN, RN
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 269
Mailing Address - Street 2:
Mailing Address - City:ANIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99557-0269
Mailing Address - Country:US
Mailing Address - Phone:907-675-4556
Mailing Address - Fax:907-675-4687
Practice Address - Street 1:260 MORGAN RD
Practice Address - Street 2:
Practice Address - City:ANIAK
Practice Address - State:AK
Practice Address - Zip Code:99557
Practice Address - Country:US
Practice Address - Phone:907-675-4556
Practice Address - Fax:907-675-4687
Is Sole Proprietor?:No
Enumeration Date:2013-10-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-77939163WC0400X, 163WC1500X, 163WH0200X
AK105990163WC0400X, 163WA2000X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health