Provider Demographics
NPI:1558384826
Name:BROWN, KIMBERLEY ANNA (PA C)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:ANNA
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:KIMBERLEY
Other - Middle Name:ANNA
Other - Last Name:WRAGGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5500 PINE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3389
Mailing Address - Country:US
Mailing Address - Phone:402-489-8888
Mailing Address - Fax:402-421-1945
Practice Address - Street 1:5500 PINE LAKE RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-3389
Practice Address - Country:US
Practice Address - Phone:402-489-8888
Practice Address - Fax:402-421-1945
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1043363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
37314OtherBLUE CROSS BLUE SHIELD
238809OtherMIDLANDS CHOICE
1900420OtherUNITED HEALTH CARE
970028870OtherRR MEDICARE
276157Medicare ID - Type Unspecified
37314OtherBLUE CROSS BLUE SHIELD