Provider Demographics
NPI:1467200758
Name:STEVENS, KIMBERLY ANN (APNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:STEVENS
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 RIVERWAY
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-3430
Mailing Address - Country:US
Mailing Address - Phone:850-565-0060
Mailing Address - Fax:
Practice Address - Street 1:1186 APPLETON RD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1906
Practice Address - Country:US
Practice Address - Phone:920-727-8700
Practice Address - Fax:920-727-8740
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15343-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily