Basic Information
| Provider Information | |||||||||
| NPI: | 1275616492 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1066 | ||||||||
| Address2: | 4508 38TH STREET SUITE 165 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025647200 | ||||||||
| FaxNumber: | 4025647210 | ||||||||
| Practice Location | |||||||||
| Address1: | 3775 45TH AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 686014427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025647200 | ||||||||
| FaxNumber: | 4025647210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 05/30/2012 | ||||||||
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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 | 208000000X | 155 | NE | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 10025279800 | 05 | NE | MEDICAID |