Provider Demographics
NPI:1477988277
Name:DENT, KIMBERLY JO (FNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JO
Last Name:DENT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MERCY WAY
Mailing Address - Street 2:STE 450
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4524
Mailing Address - Country:US
Mailing Address - Phone:417-627-8377
Mailing Address - Fax:417-627-8378
Practice Address - Street 1:100 MERCY WAY
Practice Address - Street 2:STE 450
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4524
Practice Address - Country:US
Practice Address - Phone:417-627-8377
Practice Address - Fax:417-627-8378
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013032478363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201083650AMedicaid
MO1477988277Medicaid
OK200523270AMedicaid
MOP01265331OtherRAIL ROAD MEDICARE
OK200523270AMedicaid