Provider Demographics
NPI:1770964728
Name:HENRIQUES, KIMBERLY R (APRN-AGACNP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:R
Last Name:HENRIQUES
Suffix:
Gender:F
Credentials:APRN-AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 HERRICK STREET
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-922-3000
Mailing Address - Fax:
Practice Address - Street 1:85 HERRICK STREET
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-922-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN64322163W00000X
MECNP151201363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400284182Medicare PIN
MEE400284178Medicare PIN