Basic Information
| Provider Information | |||||||||
| NPI: | 1083206742 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VILT | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | RAE | ||||||||
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| Credential: | MSN, RN, APRN, PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5809 SUMMIT VIEW LN | ||||||||
| Address2: | |||||||||
| City: | CRESTWOOD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 400149660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026191953 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3430 NEWBURG RD STE 210 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402182458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024548800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2021 | ||||||||
| LastUpdateDate: | 02/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 1130985 | KY | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363LP0808X | 3015815 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.