Provider Demographics
NPI:1780664938
Name:MCDORMAN, KIMBERLY (CRNA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MCDORMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8080 E CENTRAL AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2368
Mailing Address - Country:US
Mailing Address - Phone:316-686-7327
Mailing Address - Fax:316-858-1556
Practice Address - Street 1:8080 E CENTRAL AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2368
Practice Address - Country:US
Practice Address - Phone:316-686-7327
Practice Address - Fax:316-858-1556
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS55020367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS145029OtherBCBS
KS100405810CMedicaid
KSP00153681OtherRAILROAD MEDICARE
KS145029OtherBCBS