Provider Demographics
NPI:1932283751
Name:STECK, KIMBERLY A (NP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:STECK
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 1:2697 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1701
Mailing Address - Country:US
Mailing Address - Phone:585-546-2771
Mailing Address - Fax:585-454-7001
Practice Address - Street 1:2697 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1701
Practice Address - Country:US
Practice Address - Phone:585-546-2771
Practice Address - Fax:585-454-7001
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF4205221363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
000560620001OtherBCBS
NYRA0257Medicare ID - Type Unspecified
Q03359Medicare UPIN