Provider Demographics
NPI:1265060206
Name:GLOVER, KIMBERLY
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:GLOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:STORKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:925 SIERRA VISTA DR #312
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169
Mailing Address - Country:US
Mailing Address - Phone:612-702-1938
Mailing Address - Fax:725-205-2580
Practice Address - Street 1:1810 E SAHARA AVE
Practice Address - Street 2:STE 215
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104
Practice Address - Country:US
Practice Address - Phone:702-237-0288
Practice Address - Fax:725-205-2580
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20201730463202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology