Provider Demographics
NPI:1518078260
Name:DEATS, KIMBERLEY A (MPAS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:A
Last Name:DEATS
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:909 N 96TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2497
Mailing Address - Country:US
Mailing Address - Phone:402-330-4555
Mailing Address - Fax:402-934-0945
Practice Address - Street 1:909 N 96TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2497
Practice Address - Country:US
Practice Address - Phone:402-330-4555
Practice Address - Fax:402-934-0945
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1146363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP00166317OtherRAILROAD MEDICARE
NEP00166317OtherRAILROAD MEDICARE