Individual
KIMBERLY A BERTHOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, BC, FNP
Contact information
Practice address
20 NE SAINT LUKES BLVD, SUITE 240, LEES SUMMIT, MO 64086-6001
(816) 931-1883
(816) 756-3645
Mailing address
4330 WORNALL RD, SUITE 2000, KANSAS CITY, MO 64111-5939
(816) 931-1883
(816) 756-3645
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2008001025
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780825570
—
MO
05
—
200258340D
—
KS
05
—
200258340E
—
KS
01
—
P00836071
RAILROAD MEDICARE
MO
01
—
P00842733
RAILROAD MEDICARE
KS
Enumeration date
03/09/2009
Last updated
05/08/2012
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