Provider Demographics
NPI:1699275305
Name:BAIN, KIMBERLY KAY (ARNP-C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAY
Last Name:BAIN
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:KAY
Other - Last Name:LOUCKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 PINELLAS ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3804
Mailing Address - Country:US
Mailing Address - Phone:727-461-8231
Mailing Address - Fax:727-298-6637
Practice Address - Street 1:300 PINELLAS ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3804
Practice Address - Country:US
Practice Address - Phone:727-461-8231
Practice Address - Fax:727-298-6637
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9193019363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111655100Medicaid