Provider Demographics
NPI:1952640369
Name:GLASGOW, KIMBERLY ELAINE (NP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ELAINE
Last Name:GLASGOW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ELAINE
Other - Last Name:PLATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1655 E SAN MARNAN DR STE H
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-4378
Mailing Address - Country:US
Mailing Address - Phone:319-232-2281
Mailing Address - Fax:319-232-1404
Practice Address - Street 1:1655 E SAN MARNAN DR STE H
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-4378
Practice Address - Country:US
Practice Address - Phone:319-232-2281
Practice Address - Fax:319-232-1404
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR2042150363LF0000X
WI5640-33363LF0000X
IAA122442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1952640369Medicaid