Provider Demographics
NPI:1154352623
Name:ZWEYGARDT, KIMBERLY SUE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:SUE
Last Name:ZWEYGARDT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCIS
Mailing Address - State:KS
Mailing Address - Zip Code:67756-0347
Mailing Address - Country:US
Mailing Address - Phone:785-332-2104
Mailing Address - Fax:785-332-3255
Practice Address - Street 1:210 WEST 1ST
Practice Address - Street 2:
Practice Address - City:SAINT FRANCIS
Practice Address - State:KS
Practice Address - Zip Code:67756-0347
Practice Address - Country:US
Practice Address - Phone:785-332-2104
Practice Address - Fax:785-332-3255
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS134470042163W00000X
KS54254367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100252780DMedicaid
KS101711OtherBCBS