Provider Demographics
NPI:1619990918
Name:SCHMID, KIMBERLY K (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:SCHMID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 W 15TH AVE # F
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-9803
Mailing Address - Country:US
Mailing Address - Phone:620-343-2500
Mailing Address - Fax:620-343-2828
Practice Address - Street 1:1602 W 15TH AVE STE F
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-9803
Practice Address - Country:US
Practice Address - Phone:620-343-2500
Practice Address - Fax:620-343-2828
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-27403207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS103267OtherBC/BS OF KANSAS
KS100178OtherHPK INSURANCE
KS04-27403OtherMEDICAL LINCENSE
KS169622OtherCOVENTRY INSURANCE
KS2086174402Medicaid
KS04-27403OtherMEDICAL LINCENSE
KS04-27403OtherMEDICAL LINCENSE
KSBS5861299OtherDEA CERTIFICATE