Provider Demographics
NPI:1811793946
Name:BLOMBERG, KENDRA JO (APRN, CNP, RN)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:JO
Last Name:BLOMBERG
Suffix:
Gender:F
Credentials:APRN, CNP, RN
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:JO
Other - Last Name:AUSMUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 COMMUNITY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-8804
Mailing Address - Country:US
Mailing Address - Phone:660-885-8131
Mailing Address - Fax:
Practice Address - Street 1:1000 W NIFONG BLVD BLDG 6
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5615
Practice Address - Country:US
Practice Address - Phone:844-853-8937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007018601163W00000X
IL041509652163W00000X
MO2024045263363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse