Provider Demographics
NPI:1083411615
Name:MORTON, KIMBERLY DENYIEL
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DENYIEL
Last Name:MORTON
Suffix:
Gender:
Credentials:
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:DENYIEL
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13306 S 24TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-2017
Mailing Address - Country:US
Mailing Address - Phone:785-341-0222
Mailing Address - Fax:
Practice Address - Street 1:13306 S 24TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-2017
Practice Address - Country:US
Practice Address - Phone:785-341-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE83780374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE18483088Medicaid