Basic Information
| Provider Information | |||||||||
| NPI: | 1730131160 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MULHOLLAND | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 915 13TH AVE N | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | IA | ||||||||
| PostalCode: | 527325067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5632432511 | ||||||||
| FaxNumber: | 5632430817 | ||||||||
| Practice Location | |||||||||
| Address1: | 1705 16TH AVE | ||||||||
| Address2: | |||||||||
| City: | FULTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612529708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8155892121 | ||||||||
| FaxNumber: | 8155894468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 03/15/2013 | ||||||||
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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 | 363LF0000X | A-088981 | IA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 041-300155 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 09822109 | 01 | IL | BC/BS | OTHER | 152962 | 01 | IOWA HEALTH SOLUTIONS | OTHER | IA0190 | 01 | JOHN DEERE HEALTH | OTHER | 058573 | 01 | HEALTH ALLIANCE | OTHER | 19346 | 01 | MIDLANDS CHOICE | OTHER | 28956 | 01 | IA | WELLMARK BC/BS | OTHER | 1441170 | 05 | IA | MEDICAID |