Provider Demographics
NPI:1255547311
Name:OGDEN, KIMBERLY (NP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:OGDEN
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 1:8340 MISSION RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66206-1355
Mailing Address - Country:US
Mailing Address - Phone:913-642-2100
Mailing Address - Fax:913-642-2127
Practice Address - Street 1:8340 MISSION ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-4801
Practice Address - Country:US
Practice Address - Phone:913-642-2100
Practice Address - Fax:913-642-2127
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO150752363L00000X
KS45726363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOQ06112Medicare UPIN