Provider Demographics
NPI:1215992706
Name:KIMMES, STEPHANIE ANN (APRN CNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:KIMMES
Suffix:
Gender:F
Credentials:APRN CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 1ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:ORONOCO
Mailing Address - State:MN
Mailing Address - Zip Code:55960
Mailing Address - Country:US
Mailing Address - Phone:507-259-2846
Mailing Address - Fax:
Practice Address - Street 1:HELPCARE CLINIC
Practice Address - Street 2:308 4TH AVE NW
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912
Practice Address - Country:US
Practice Address - Phone:507-279-2345
Practice Address - Fax:833-340-7428
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR117259-7363L00000X, 363LF0000X
MNR-117259-7363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN410993700Medicaid
MNENROLLEDMedicaid
IAENROLLEDMedicaid
MN500005389Medicare PIN
MN500006338Medicare PIN