Provider Demographics
NPI:1609271709
Name:LE, KIM T (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:T
Last Name:LE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:MO
Mailing Address - Zip Code:64060-8638
Mailing Address - Country:US
Mailing Address - Phone:816-635-2777
Mailing Address - Fax:816-635-2712
Practice Address - Street 1:425 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:MO
Practice Address - Zip Code:64060-8638
Practice Address - Country:US
Practice Address - Phone:816-635-2777
Practice Address - Fax:816-635-2712
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014035618363LF0000X
KS53-77112363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner