Basic Information
| Provider Information | |||||||||
| NPI: | 1104151307 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DISHMAN | ||||||||
| FirstName: | KIMBERLY | ||||||||
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| Credential: | WHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5811 W 78TH TER | ||||||||
| Address2: | |||||||||
| City: | PRAIRIE VILLAGE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662084622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7734199214 | ||||||||
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| Practice Location | |||||||||
| Address1: | 407 S CLAIRBORNE RD STE 104 | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660621744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136482266 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2009 | ||||||||
| LastUpdateDate: | 08/06/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 209-007802 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.