Provider Demographics
NPI:1205426228
Name:IRELAND, KIMBERLY JOY (BSN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JOY
Last Name:IRELAND
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21600 W 100TH TER
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66220-3751
Mailing Address - Country:US
Mailing Address - Phone:913-424-8592
Mailing Address - Fax:
Practice Address - Street 1:21600 W 100TH TER
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66220-3751
Practice Address - Country:US
Practice Address - Phone:913-424-8592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-23
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-126871-081163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care