Provider Demographics
NPI:1265738181
Name:CASEY, KIMBERLY (LPN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CASEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2658 HEARTLAND DR NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3043
Mailing Address - Country:US
Mailing Address - Phone:507-993-2650
Mailing Address - Fax:
Practice Address - Street 1:2658 HEARTLAND DR NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3043
Practice Address - Country:US
Practice Address - Phone:507-993-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL064216-7164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse