Provider Demographics
NPI:1679026447
Name:KIMBERLY DREWREY, APRN, NP-C
Entity Type:Organization
Organization Name:KIMBERLY DREWREY, APRN, NP-C
Other - Org Name:TREASURE VALLEY MOBILE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER, BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DREWREY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:208-866-4962
Mailing Address - Street 1:5210 CLEVELAND BLVD
Mailing Address - Street 2:SUITE 140 #344
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-1796
Mailing Address - Country:US
Mailing Address - Phone:208-866-4962
Mailing Address - Fax:
Practice Address - Street 1:5210 CLEVELAND BLVD
Practice Address - Street 2:SUITE 140 #344
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-1796
Practice Address - Country:US
Practice Address - Phone:208-866-4962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP1103A305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service