Individual
KIMBERLY L KOORS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2401 W UNIVERSITY AVE, MUNCIE, IN 47303-3428
(765) 751-1720
(765) 281-6567
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
28199727A
IN
363LF0000X
Family Nurse Practitioner
Primary
71008676A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
28199727A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001242836
ANTHEM PTAN
IN
01
—
000001242850
ANTHEM PTAN
IN
01
—
000001413068
ANTHEM PTAN
IN
05
—
300022855
—
IN
Enumeration date
01/15/2019
Last updated
02/12/2025
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