1346536448 NPI number — KIMBERLY KAY GOLDER RN, BSN, ARNP

Table of content: KIMBERLY KAY GOLDER RN, BSN, ARNP (NPI 1346536448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346536448 NPI number — KIMBERLY KAY GOLDER RN, BSN, ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDER
Provider First Name:
KIMBERLY
Provider Middle Name:
KAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, BSN, ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ABBOTT
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346536448
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 SW 10TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOPEKA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66604-1301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-354-6000
Provider Business Mailing Address Fax Number:
785-354-5070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 SW 10TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66604-1301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-354-6000
Provider Business Practice Location Address Fax Number:
785-354-5070
Provider Enumeration Date:
06/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  75397 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 068002131 . This is a "MEDICARE PTAN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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