Provider Demographics
NPI:1750783346
Name:CORDES, KIMBERLY K (AGNP-BC, CVNP-BC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:CORDES
Suffix:
Gender:F
Credentials:AGNP-BC, CVNP-BC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:K
Other - Last Name:BERNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGNP-BC
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:6500 HOSPITAL DRIVE
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-1239
Mailing Address - Country:US
Mailing Address - Phone:573-629-3300
Mailing Address - Fax:573-629-3314
Practice Address - Street 1:6500 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6890
Practice Address - Country:US
Practice Address - Phone:573-629-3300
Practice Address - Fax:573-629-3314
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO124307163W00000X
MO2014037312363LG0600X, 363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology