Provider Demographics
NPI:1861489189
Name:WESTRA, KIMBERLY A (CRNA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:WESTRA
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 1:14119 SEA CAPTAIN RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21842-5637
Mailing Address - Country:US
Mailing Address - Phone:215-917-6678
Mailing Address - Fax:
Practice Address - Street 1:640 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3530
Practice Address - Country:US
Practice Address - Phone:302-674-4700
Practice Address - Fax:302-744-6407
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN354673L163W00000X
PA053594367500000X
DEL6-0A00820367500000X
VA0024183064367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018704150005Medicaid
PA2106205000OtherINDEP. BLUE CROSS
PA1419911OtherKHP CENTRAL
PA11803087OtherCAQH
PA50003224OtherCAPITAL ADVANTAGE
PA1419911OtherFIRST PRIORITY
PA1542843OtherGATEWAY
PA1419911OtherHIGHMARK
PA77529OtherGEISINGER
PA9401436OtherAETNA
PAP55205Medicare UPIN
PA9401436OtherAETNA
PA0018704150005Medicaid