Provider Demographics
NPI:1679635478
Name:LABRONTE, KIMBERLY MAE (NNP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:MAE
Last Name:LABRONTE
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:MAE
Other - Last Name:HORNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NNP
Mailing Address - Street 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-625-5085
Mailing Address - Fax:208-625-5731
Practice Address - Street 1:2003 KOOTENAI HEALTH WAY
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-6051
Practice Address - Country:US
Practice Address - Phone:518-520-8625
Practice Address - Fax:208-625-6892
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP62467363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ154127Medicaid