Provider Demographics
NPI:1023344975
Name:DOAN, KIMBERLY S (APRN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:DOAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:4915 NORTON HEALTHCARE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2861
Practice Address - Country:US
Practice Address - Phone:502-891-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2009006807363LA2100X
KY3006384363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY170502OtherSIHO
KY7100113610Medicaid
KY000000652647OtherANTHEM
KY000000912348OtherANTHEM-NIS
KY50082145OtherPASSPORT
IN200981270Medicaid
KY170502OtherSIHO
KY00546265Medicare Oscar/Certification