Provider Demographics
NPI:1538292230
Name:JEFVERT, KIMBERLY K (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:JEFVERT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:K
Other - Last Name:JEFVERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:1282 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:DAWSON
Mailing Address - State:MN
Mailing Address - Zip Code:56232-2333
Mailing Address - Country:US
Mailing Address - Phone:320-769-4393
Mailing Address - Fax:332-769-2972
Practice Address - Street 1:3920 ST FRANCIS WAY STE 209
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4917
Practice Address - Country:US
Practice Address - Phone:765-775-2830
Practice Address - Fax:765-775-2826
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000683A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201008840Medicaid
IN201008840Medicaid