Basic Information
| Provider Information | |||||||||
| NPI: | 1053681684 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEPHENSON | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | C.E. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5780 COWBOY FIDDLE CT | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891311991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027858428 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2380 W HORIZON RIDGE PKWY | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890525078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028234255 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2012 | ||||||||
| LastUpdateDate: | 12/12/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | RN57135 | NV | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 163WE0003X | RN57135 | NV | N | Nursing Service Providers | Registered Nurse | Emergency | 363LF0000X | APRN001672 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.