Provider Demographics
NPI:1063411387
Name:HARMON, KIMBERLY JANE (DPM)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:JANE
Last Name:HARMON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 DUFF AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-6609
Mailing Address - Country:US
Mailing Address - Phone:515-233-0943
Mailing Address - Fax:515-663-8052
Practice Address - Street 1:217 DUFF AVE
Practice Address - Street 2:STE 2
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6609
Practice Address - Country:US
Practice Address - Phone:515-233-0943
Practice Address - Fax:515-663-8052
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00664213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA20196OtherBLUE CROSS/BLUE SHIELD
IA2168591Medicaid
IA480030395OtherRAILROAD MEDICARE
IA20196OtherBLUE CROSS/BLUE SHIELD
IA5012960001Medicare NSC