Provider Demographics
NPI:1174556468
Name:SICKELS, KIMBERLEE ANNETTE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:KIMBERLEE
Middle Name:ANNETTE
Last Name:SICKELS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:1020 VETERANS PKWY STE 700
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-2390
Practice Address - Country:US
Practice Address - Phone:812-668-8144
Practice Address - Fax:877-772-5243
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4488P363LA2200X
IN71000724A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
INS89600Medicare UPIN