Provider Demographics
NPI:1265903447
Name:ALDIS, KIMBERLY J (CRNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:ALDIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SIVLEY RD SW STE 200
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5177
Mailing Address - Country:US
Mailing Address - Phone:562-651-8222
Mailing Address - Fax:256-265-1825
Practice Address - Street 1:201 SIVLEY RD SW STE 200
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5177
Practice Address - Country:US
Practice Address - Phone:256-265-1822
Practice Address - Fax:256-265-1825
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041326489163WX0200X
IL209018688363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WX0200XNursing Service ProvidersRegistered NurseOncology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily