Doctor Name: | DR. KIMBERLY DIANE KEARNEY |
NPI Number: | 1043613888 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DNP |
License Number: | 34454.1357 |
Business Practice Address: | 1233 East Second Street Casper, WY - 82601 |
Business Phone Number: | 5052388639 |
Business Fax Number: | |
Mailing Address: | 1233 East Second Street, CASPER |
State: | WY |
Postal Code: | 82601 |
Phone Number: | 5052388639 |
Fax Number: | |
NPI Enumeration Date: | 10/08/2014 |
NPI Last Update Date: | 12/29/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 34454.1357 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |