Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 3006384 | KY |
N | 363LA2100X | Nurse Practitioner - Acute Care | 2009006807 | KY |
NPI | 1023344975 |
---|---|
Provider Name | Kimberly S Doan |
First Address | Chicago, IL 60677-6351 |
Second Address | Louisville, KY 40241-2861 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2009 |
Last Update Date | 23/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000652647 | ANTHEM (01) | KY |
000000912348 | ANTHEM-NIS (01) | KY |
170502 | SIHO (01) | KY |
200981270 | (05) | IN |
50082145 | PASSPORT (01) | KY |
7100113610 | (05) | KY |