Provider Demographics
NPI:1730131160
Name:MULHOLLAND, KIMBERLY K (ARNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:MULHOLLAND
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 13TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-5067
Mailing Address - Country:US
Mailing Address - Phone:563-243-2511
Mailing Address - Fax:563-243-0817
Practice Address - Street 1:1705 16TH AVE
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:IL
Practice Address - Zip Code:61252-9708
Practice Address - Country:US
Practice Address - Phone:815-589-2121
Practice Address - Fax:815-589-4468
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-088981363LF0000X
IL041-300155363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09822109OtherBC/BS
152962OtherIOWA HEALTH SOLUTIONS
IA0190OtherJOHN DEERE HEALTH
058573OtherHEALTH ALLIANCE
19346OtherMIDLANDS CHOICE
IA28956OtherWELLMARK BC/BS
IA1441170Medicaid
19346OtherMIDLANDS CHOICE
IL$$$$$$$$$00Medicaid
IL09822109OtherBC/BS
IL500024332Medicare PIN
19346OtherMIDLANDS CHOICE
IA500015843Medicare PIN
ILK45516Medicare PIN