Provider Demographics
NPI:1396534871
Name:SUMMERS, KIMBERLY
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 BRUCE DR
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:IL
Mailing Address - Zip Code:62092-1178
Mailing Address - Country:US
Mailing Address - Phone:217-939-1307
Mailing Address - Fax:
Practice Address - Street 1:121 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:IL
Practice Address - Zip Code:62016-1340
Practice Address - Country:US
Practice Address - Phone:217-939-0236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043078572164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse