Provider Demographics
NPI:1902232945
Name:BICE, KIMBERLY (NP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BICE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 MICHIGAN AVE
Mailing Address - Street 2:STE 140
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-1530
Mailing Address - Country:US
Mailing Address - Phone:574-753-1462
Mailing Address - Fax:574-753-1465
Practice Address - Street 1:1201 MICHIGAN AVE
Practice Address - Street 2:STE 140
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1530
Practice Address - Country:US
Practice Address - Phone:574-753-1462
Practice Address - Fax:574-753-1465
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004652A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000869195OtherANTHEM
IN201196430Medicaid
IN000000837494OtherANTHEM PROVIDER NUMBER
IN201196430Medicaid
INP01271410Medicare PIN
IN940670019Medicare PIN