Provider Demographics
NPI:1568865731
Name:ZINKOVICH, KIMBERLEY A (NP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:A
Last Name:ZINKOVICH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2723 S 7TH STREET ST A
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-3558
Mailing Address - Country:US
Mailing Address - Phone:812-238-1730
Mailing Address - Fax:812-242-1565
Practice Address - Street 1:2723 S 7TH ST STE O
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-3562
Practice Address - Country:US
Practice Address - Phone:812-232-1418
Practice Address - Fax:812-234-7362
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005134A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201253870Medicaid
INP01453972OtherRAILROAD MEDICARE
IN000000895306OtherANTHEM
IN147180017Medicare PIN