Basic Information
| Provider Information | |||||||||
| NPI: | 1437586476 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADDEN | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | MSN, RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 269 | ||||||||
| Address2: | |||||||||
| City: | ANIAK | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995570269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9076754556 | ||||||||
| FaxNumber: | 9076754687 | ||||||||
| Practice Location | |||||||||
| Address1: | 260 MORGAN RD | ||||||||
| Address2: | |||||||||
| City: | ANIAK | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9076754556 | ||||||||
| FaxNumber: | 9076754687 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2013 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 163WC0400X | RN-77939 | NM | N | Nursing Service Providers | Registered Nurse | Case Management | 163WC0400X | 105990 | AK | N | Nursing Service Providers | Registered Nurse | Case Management | 163WA2000X | 105990 | AK | Y | Nursing Service Providers | Registered Nurse | Administrator | 163WC1500X | RN-77939 | NM | N | Nursing Service Providers | Registered Nurse | Community Health | 163WC1500X | 105990 | AK | N | Nursing Service Providers | Registered Nurse | Community Health | 163WH0200X | RN-77939 | NM | N | Nursing Service Providers | Registered Nurse | Home Health |
No ID Information.