Provider Demographics
NPI:1790207207
Name:ZIMMERMAN, KAYLIE D'ANN (APRN-MSN)
Entity Type:Individual
Prefix:
First Name:KAYLIE
Middle Name:D'ANN
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:APRN-MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 COLUMBINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436-8824
Mailing Address - Country:US
Mailing Address - Phone:785-364-2116
Mailing Address - Fax:785-364-9613
Practice Address - Street 1:1110 COLUMBINE DRIVE
Practice Address - Street 2:
Practice Address - City:HOLTON
Practice Address - State:KS
Practice Address - Zip Code:66436-8824
Practice Address - Country:US
Practice Address - Phone:785-364-2116
Practice Address - Fax:785-364-9613
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS77746363L00000X
KS53-77746363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner