Individual
MS. KIMBERLY DENISE SOUZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
400 E COURT AVE STE 110, DES MOINES, IA 50309-2027
(860) 788-6404
Mailing address
PO BOX 1595, MIDDLETOWN, CT 06457-8095
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2014035648
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12803160
CAQH
—
01
—
MA3251006
MEDICARE PROVIDER TRANSACTION ACCESS NUMBER
MO
Enumeration date
10/09/2014
Last updated
09/04/2024
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