Provider Demographics
NPI:1366562001
Name:BYWATERS, KIMBERLY JOYCE (RN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JOYCE
Last Name:BYWATERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 E 117TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64134-3701
Mailing Address - Country:US
Mailing Address - Phone:816-554-4285
Mailing Address - Fax:816-554-5550
Practice Address - Street 1:6801 E 117TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64134-3701
Practice Address - Country:US
Practice Address - Phone:816-554-4285
Practice Address - Fax:816-554-5550
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-60603-022163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2001022863Other2001022863
KS100098080AMedicaid