Provider Demographics
NPI:1467910109
Name:FALLER, KIMBERLEI M (FNP-BC, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KIMBERLEI
Middle Name:M
Last Name:FALLER
Suffix:
Gender:F
Credentials:FNP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 HOWARD ST W
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-2303
Mailing Address - Country:US
Mailing Address - Phone:386-319-0709
Mailing Address - Fax:855-616-8455
Practice Address - Street 1:215 HOWARD ST W
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-2303
Practice Address - Country:US
Practice Address - Phone:386-319-0709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11001792363L00000X
FLAPRN11001972363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner