Individual
KIMBERLY S PENLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC, P.H.D.
Contact information
Practice address
5110 N CLINTON ST, FORT WAYNE, IN 46825-5720
(260) 469-6605
(260) 969-3066
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71001183A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000368990
ANTHEM
IN
05
—
200329110
—
IN
01
—
500024449
RR MEDICARE
IN
Enumeration date
11/02/2005
Last updated
10/14/2022
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