Provider Demographics
NPI:1194495424
Name:CLAFFEY, KIMBERLY RENE (FNP-C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RENE
Last Name:CLAFFEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 LAKE TER NE STE WC
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-9665
Mailing Address - Country:US
Mailing Address - Phone:618-899-5001
Mailing Address - Fax:618-242-5152
Practice Address - Street 1:5100 LAKE TER NE STE WC
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-9665
Practice Address - Country:US
Practice Address - Phone:618-899-5001
Practice Address - Fax:618-242-5152
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.024017363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily