Provider Demographics
NPI:1649919903
Name:HENDL, KIMBERLY ANNE (APRN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE
Last Name:HENDL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 RUMSEY RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:PHILIPSBURG
Mailing Address - State:MT
Mailing Address - Zip Code:59858-9729
Mailing Address - Country:US
Mailing Address - Phone:208-821-5822
Mailing Address - Fax:
Practice Address - Street 1:4 RUMSEY RIDGE TRL
Practice Address - Street 2:
Practice Address - City:PHILIPSBURG
Practice Address - State:MT
Practice Address - Zip Code:59858-9729
Practice Address - Country:US
Practice Address - Phone:208-821-5822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-194864363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health