Provider Demographics
NPI:1053018622
Name:BENTLEY, KIMBERLY MENIQUE (FNP-BC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MENIQUE
Last Name:BENTLEY
Suffix:
Gender:
Credentials:FNP-BC
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 932958
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:212 KROGER WAY
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1991
Practice Address - Country:US
Practice Address - Phone:859-297-1072
Practice Address - Fax:859-297-1073
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1112837163W00000X
KY3019026363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse