Provider Demographics
NPI:1639152572
Name:HISER, KIMBERLY A (APRN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:HISER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 R ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-3723
Mailing Address - Country:US
Mailing Address - Phone:402-465-4545
Mailing Address - Fax:402-465-3621
Practice Address - Street 1:4545 R ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68503-3723
Practice Address - Country:US
Practice Address - Phone:402-465-4545
Practice Address - Fax:402-465-3621
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110681363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEQ38319Medicare UPIN