Provider Demographics
NPI:1932455052
Name:RINES, KIMBERLY LYNN (ARNP, MSN, RN)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:LYNN
Last Name:RINES
Suffix:
Gender:F
Credentials:ARNP, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 200TH ST
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:IA
Mailing Address - Zip Code:51566-3218
Mailing Address - Country:US
Mailing Address - Phone:712-629-0040
Mailing Address - Fax:712-566-5049
Practice Address - Street 1:1959 200TH ST
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:IA
Practice Address - Zip Code:51566-3218
Practice Address - Country:US
Practice Address - Phone:712-629-0040
Practice Address - Fax:712-566-5049
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH131507363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1932455052Medicaid
NE47068731710Medicaid
NE47068731710Medicaid