Provider Demographics
NPI:1922299866
Name:WOOD, KIMBERLY OBRIEN (APRN-BC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:OBRIEN
Last Name:WOOD
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 N HIGHWAY 69
Mailing Address - Street 2:
Mailing Address - City:FRONTENAC
Mailing Address - State:KS
Mailing Address - Zip Code:66763-8100
Mailing Address - Country:US
Mailing Address - Phone:620-235-1377
Mailing Address - Fax:
Practice Address - Street 1:1011 N HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:FRONTENAC
Practice Address - State:KS
Practice Address - Zip Code:66763-8100
Practice Address - Country:US
Practice Address - Phone:620-235-1377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45227363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily