Provider Demographics
NPI:1912613928
Name:DEAVER, KIMBERLEY (APRN)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:DEAVER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 W ROSEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-3171
Mailing Address - Country:US
Mailing Address - Phone:316-759-9492
Mailing Address - Fax:
Practice Address - Street 1:9390 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2533
Practice Address - Country:US
Practice Address - Phone:316-733-4747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5381881021363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily