Provider Demographics
NPI:1497036297
Name:TE, KIMBERLY DAWN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DAWN
Last Name:TE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:DAWN
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 E. HARBIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:PUXICO
Mailing Address - State:MO
Mailing Address - Zip Code:63960-9104
Mailing Address - Country:US
Mailing Address - Phone:573-222-3557
Mailing Address - Fax:573-222-3127
Practice Address - Street 1:130 E HARBIN AVE
Practice Address - Street 2:
Practice Address - City:PUXICO
Practice Address - State:MO
Practice Address - Zip Code:63960-9104
Practice Address - Country:US
Practice Address - Phone:573-222-3557
Practice Address - Fax:573-222-3127
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011027099363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily