Provider Demographics
NPI:1366927667
Name:GILLIANS, KIMBERLEY ELAINE (APRN)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:ELAINE
Last Name:GILLIANS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 MOUNT MORIAH AVE
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-7834
Mailing Address - Country:US
Mailing Address - Phone:270-925-4248
Mailing Address - Fax:
Practice Address - Street 1:8211 W STATE ROUTE 66
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-2534
Practice Address - Country:US
Practice Address - Phone:812-490-0463
Practice Address - Fax:812-379-8031
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012866363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily