Provider Demographics
NPI:1912666108
Name:GILMORE, KIMBERLY WUTSNU-BEATRICE
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:WUTSNU-BEATRICE
Last Name:GILMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9433 HIMEBAUGH CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-1600
Mailing Address - Country:US
Mailing Address - Phone:402-706-1357
Mailing Address - Fax:
Practice Address - Street 1:15652 N 4TH ST APT 11
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NE
Practice Address - Zip Code:68007-5453
Practice Address - Country:US
Practice Address - Phone:402-812-9156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE458767373747P1801X
NE86862439372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE86826439Medicaid
NE45876737Medicaid