Provider Demographics
NPI:1659468213
Name:CAMP-GRIMIT, KIMBERLY K (APRN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:CAMP-GRIMIT
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 1:680 E FREMONT MEDICAL PARK DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2309
Mailing Address - Country:US
Mailing Address - Phone:402-941-7245
Mailing Address - Fax:402-941-7244
Practice Address - Street 1:680 E FREMONT MEDICAL PARK DR STE 300
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2309
Practice Address - Country:US
Practice Address - Phone:402-941-7245
Practice Address - Fax:402-941-7244
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110773363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE110773OtherSTATE LICENSE