Provider Demographics
NPI:1902694714
Name:VANOVER-BARDO, KIMBERLY MAUREEN (FNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MAUREEN
Last Name:VANOVER-BARDO
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:M
Other - Last Name:KREITZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:17509 COUNTY ROAD 25A
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-7748
Mailing Address - Country:US
Mailing Address - Phone:419-236-1922
Mailing Address - Fax:
Practice Address - Street 1:17509 COUNTY ROAD 25A
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-7748
Practice Address - Country:US
Practice Address - Phone:419-236-1922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0039062363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty