Provider Demographics
NPI:1912666108
Name:GILMORE, KIMBERLY B
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:B
Last Name:GILMORE
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 1:9433 HIMEBAUGH CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-1600
Mailing Address - Country:US
Mailing Address - Phone:402-706-1357
Mailing Address - Fax:
Practice Address - Street 1:3204 N. 162ND COURT
Practice Address - Street 2:104
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116
Practice Address - Country:US
Practice Address - Phone:402-885-8287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE458767373747P1801X
NE86862439372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE45876737Medicaid
NE86826439Medicaid