Provider Demographics
NPI:1922855543
Name:DEVRIES, KIMBERLY (RN, CLC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:DEVRIES
Suffix:
Gender:F
Credentials:RN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2593 US HIGHWAY 2 E STE 1
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-9507
Mailing Address - Country:US
Mailing Address - Phone:406-890-2212
Mailing Address - Fax:
Practice Address - Street 1:2593 US HIGHWAY 2 E STE 1
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-9507
Practice Address - Country:US
Practice Address - Phone:406-890-2212
Practice Address - Fax:406-890-2344
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN-126596163WL0100X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant