Provider Demographics
NPI:1982332433
Name:ANDERSON, KIMBERLY L (RN BSN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11721 S TATTERED ANGEL CV
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-4110
Mailing Address - Country:US
Mailing Address - Phone:385-223-7853
Mailing Address - Fax:
Practice Address - Street 1:11721 S TATTERED ANGEL CV
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-4110
Practice Address - Country:US
Practice Address - Phone:385-223-7853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2023-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12066588-3102163WS0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WS0200XNursing Service ProvidersRegistered NurseSchool