Provider Demographics
NPI:1689654667
Name:PLUMMER, KIMBERLY (CMSW LMHP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:CMSW LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 PEOPLES RD
Mailing Address - Street 2:ROOM 8
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-4670
Mailing Address - Country:US
Mailing Address - Phone:402-978-5176
Mailing Address - Fax:402-341-3616
Practice Address - Street 1:2211 PEOPLES RD
Practice Address - Street 2:ROOM 8
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-4670
Practice Address - Country:US
Practice Address - Phone:402-978-5176
Practice Address - Fax:402-341-3616
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0916627Medicaid
NE268585Medicare ID - Type Unspecified