Provider Demographics
NPI:1619960697
Name:ROSENBERG, KIMBRA A (ARNP)
Entity Type:Individual
Prefix:MS
First Name:KIMBRA
Middle Name:A
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LARNED
Mailing Address - State:KS
Mailing Address - Zip Code:67550-2920
Mailing Address - Country:US
Mailing Address - Phone:620-285-2836
Mailing Address - Fax:620-285-3660
Practice Address - Street 1:200 E 8TH ST
Practice Address - Street 2:
Practice Address - City:LARNED
Practice Address - State:KS
Practice Address - Zip Code:67550-2602
Practice Address - Country:US
Practice Address - Phone:620-285-6424
Practice Address - Fax:620-285-3660
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74245364SA2200X, 364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Not Answered364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSR31920Medicare UPIN
KS048509Medicare ID - Type Unspecified