Provider Demographics
NPI:1093502940
Name:BURTON, KIMBERLY LATRICE
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LATRICE
Last Name:BURTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 FLORENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68110-2290
Mailing Address - Country:US
Mailing Address - Phone:402-320-1790
Mailing Address - Fax:
Practice Address - Street 1:319 S 17TH ST STE 726
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-1991
Practice Address - Country:US
Practice Address - Phone:402-421-1119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372500000X372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider