Provider Demographics
NPI:1528579513
Name:KENSETH, KIMBERLY ROSE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ROSE
Last Name:KENSETH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6023 HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3053
Mailing Address - Country:US
Mailing Address - Phone:412-661-2802
Mailing Address - Fax:412-661-8020
Practice Address - Street 1:6023 HARVARD ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3053
Practice Address - Country:US
Practice Address - Phone:412-661-2802
Practice Address - Fax:412-661-8020
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017995363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner