Provider Demographics
NPI:1912337585
Name:FUTRELL, KIMBERLY (R,N)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:FUTRELL
Suffix:
Gender:F
Credentials:R,N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT OF THE ARMY, BG SAMS, USAMEDDAC-JAPAN
Mailing Address - Street 2:MCJA-NUR UNIT 45011
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96343-5011
Mailing Address - Country:US
Mailing Address - Phone:312-263-4121
Mailing Address - Fax:
Practice Address - Street 1:DEPT OF THE ARMY, BG SAMS, USAMEDDAC-JAPAN
Practice Address - Street 2:MCJA-NUR UNIT 45011
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96343-5011
Practice Address - Country:US
Practice Address - Phone:312-263-4121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC223777163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse