Provider Demographics
NPI:1174114573
Name:KIMBERLIN, REBEKAH JOY
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:JOY
Last Name:KIMBERLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BEKAH
Other - Middle Name:JOY
Other - Last Name:MALLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2200 H ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBURY
Mailing Address - State:NE
Mailing Address - Zip Code:68352-1119
Mailing Address - Country:US
Mailing Address - Phone:402-729-3351
Mailing Address - Fax:402-729-6880
Practice Address - Street 1:2200 H ST
Practice Address - Street 2:
Practice Address - City:FAIRBURY
Practice Address - State:NE
Practice Address - Zip Code:68352-1119
Practice Address - Country:US
Practice Address - Phone:402-729-3351
Practice Address - Fax:402-729-6880
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist