Provider Demographics
NPI:1194417527
Name:BAUER, KIMBERLY MARIE
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:MARIE
Last Name:BAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 SWEETWATER AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-2672
Mailing Address - Country:US
Mailing Address - Phone:308-762-4331
Mailing Address - Fax:308-762-4341
Practice Address - Street 1:1604 SWEETWATER AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-2672
Practice Address - Country:US
Practice Address - Phone:308-762-4331
Practice Address - Fax:308-762-4341
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026705200Medicaid