Provider Demographics
NPI:1205051208
Name:WHISENANT, KIMBERLY (NP)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:WHISENANT
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 1:116 E 11TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-4365
Mailing Address - Country:US
Mailing Address - Phone:712-264-3500
Mailing Address - Fax:712-264-3525
Practice Address - Street 1:116 E 11TH ST STE 101
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4365
Practice Address - Country:US
Practice Address - Phone:712-264-3500
Practice Address - Fax:712-264-3525
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX520993363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics