Provider Demographics
NPI:1063983641
Name:BENDER, KIMBERLY KATHERINE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:KATHERINE
Last Name:BENDER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CANTERBURY CIR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-4412
Mailing Address - Country:US
Mailing Address - Phone:850-362-9889
Mailing Address - Fax:
Practice Address - Street 1:740 S LIMESTONE STE D201
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-3754
Practice Address - Country:US
Practice Address - Phone:859-323-0079
Practice Address - Fax:859-323-8173
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013173363L00000X, 363LF0000X, 363LA2100X
FLAPRN9295254363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily