Provider Demographics
NPI:1952640369
Name:GLASGOW, KIMBERLY ELAINE (NP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ELAINE
Last Name:GLASGOW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ELAINE
Other - Last Name:PLATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5900 NW 86TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2284
Mailing Address - Country:US
Mailing Address - Phone:515-276-6133
Mailing Address - Fax:515-334-7356
Practice Address - Street 1:5900 NW 86TH ST STE 100
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-2284
Practice Address - Country:US
Practice Address - Phone:515-276-6133
Practice Address - Fax:515-334-7356
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR2042150363LF0000X
WI5640-33363LF0000X
IAA122442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1952640369Medicaid