Provider Demographics
NPI:1922032861
Name:ACKERMAN, KIMBERLY L (FNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4988 STONE RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-4418
Mailing Address - Country:US
Mailing Address - Phone:406-534-1627
Mailing Address - Fax:
Practice Address - Street 1:2800 10TH AVE N
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0703
Practice Address - Country:US
Practice Address - Phone:406-657-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-100462363LA2200X, 363LF0000X
MTRN26870363L00000X
MTNUR-APRN-LIC-100504363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000370601OtherMT MDCD BCBS
MT4308772OtherMT MDCD PIN
MTP00013861OtherRAILROAD MEDICARE
MT123149900OtherMT MDCD PIN
MTCI3483OtherRAILROAD MEDICARE
MT000085464Medicare PIN
MTP00013861OtherRAILROAD MEDICARE