Provider Demographics
NPI:1992936272
Name:KOERNER, KIMBERLY (APRN, RN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:KOERNER
Suffix:
Gender:F
Credentials:APRN, RN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5310 KIETZKE LN STE 104
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2043
Mailing Address - Country:US
Mailing Address - Phone:775-348-8800
Mailing Address - Fax:775-786-1358
Practice Address - Street 1:9990 DOUBLE R BLVD STE 200
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-4833
Practice Address - Country:US
Practice Address - Phone:775-348-8800
Practice Address - Fax:775-348-8818
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVAPRN001162363L00000X
NVRN64237163WX0800X
NVAPN001162363L00000X
NVTAPN700545363L00000X
WAAP60105477363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedic
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCP633ZMedicare PIN