Provider Demographics
NPI:1720337967
Name:PRIVETT, KIMBERLEY K (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:K
Last Name:PRIVETT
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 ELIZAVILLE AVE
Mailing Address - Street 2:P.O. BOX 344
Mailing Address - City:FLEMINGSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41041-1139
Mailing Address - Country:US
Mailing Address - Phone:606-849-2323
Mailing Address - Fax:606-849-2025
Practice Address - Street 1:732 ELIZAVILLE AVE
Practice Address - Street 2:
Practice Address - City:FLEMINGSBURG
Practice Address - State:KY
Practice Address - Zip Code:41041-1139
Practice Address - Country:US
Practice Address - Phone:606-849-2323
Practice Address - Fax:606-849-2025
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007601363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily