Provider Demographics
NPI:1336386226
Name:KIMBERLY S. NEACE, MSN, CNP, LLC
Entity Type:Organization
Organization Name:KIMBERLY S. NEACE, MSN, CNP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:NEACE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, CNP
Authorized Official - Phone:937-603-4507
Mailing Address - Street 1:11117 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47012-5154
Mailing Address - Country:US
Mailing Address - Phone:937-603-4507
Mailing Address - Fax:765-647-7380
Practice Address - Street 1:11117 BEECH ST
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47012-5154
Practice Address - Country:US
Practice Address - Phone:937-603-4507
Practice Address - Fax:765-647-7380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9386101Medicare UPIN