Provider Demographics
NPI:1649210790
Name:EVERS, KIMBERLY MORSE (MSN, FNP-C, CDE)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:MORSE
Last Name:EVERS
Suffix:
Gender:F
Credentials:MSN, FNP-C, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-6005
Mailing Address - Fax:612-630-8242
Practice Address - Street 1:2810 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-4708
Practice Address - Country:US
Practice Address - Phone:612-545-9000
Practice Address - Fax:612-545-9049
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0212644363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN01-13633OtherMEDICA
MNP00277496OtherRAILROAD MEDICARE
MN48G26SCOtherBLUE CROSS BLUE SHIELD
MN529316200Medicaid
MN01-13633OtherMEDICA
MNP36886Medicare UPIN
MN48G26SCOtherBLUE CROSS BLUE SHIELD