# KIMBERLY S PENLAND

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1467443036
- **Gender:** F
- **Credential:** FNP-BC, P.H.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 71001183A | IN | Yes |

## Other

- **Enumeration date:** 11/02/2005
- **Last updated:** 10/14/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000368990 | ANTHEM | IN |
| 05 | — | 200329110 | — | IN |
| 01 | — | 500024449 | RR MEDICARE | IN |