Provider Demographics
NPI:1518560994
Name:KENNEY, KIMBERLY (RN BSN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:KENNEY
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4019 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51108-1416
Mailing Address - Country:US
Mailing Address - Phone:712-212-1777
Mailing Address - Fax:
Practice Address - Street 1:4019 ADAMS ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51108-1416
Practice Address - Country:US
Practice Address - Phone:712-212-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA115642163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health