Individual provider Active NPI

Kimberly C Warstler, FNP-BC

  • Family Nurse Practitioner
  • Wright Patterson AFB, OH
National Provider Identifier
1053113860
Registry record updated Mar 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
318610 Issued in AZ
Practice address
4881 Sugar Maple Dr
Wright Patterson AFB, OH 45433-5529
Phone
(937) 257-3079
NPI assigned
Mar 25, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 318610 AZ Primary

Addresses

Primary practice location

4881 Sugar Maple Dr
Wright Patterson AFB, OH 45433-5529

Mailing address

1606 Gatekeeper Way
Dayton, OH 45458-3954
Phone (325) 864-9631

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250409001480 AZ Order and Referring Only - Nurse Practitioner 5991229171

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
318610AZMDFamily Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1742860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742860800000",
    "number": "1053113860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1606 GATEKEEPER WAY",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454583954",
            "telephone_number": "325-864-9631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4881 SUGAR MAPLE DR",
            "city": "WRIGHT PATTERSON AFB",
            "state": "OH",
            "postal_code": "454335529",
            "telephone_number": "937-257-3079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARSTLER",
        "first_name": "KIMBERLY",
        "middle_name": "C",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-03-25",
        "last_updated": "2025-03-25",
        "certification_date": "2025-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "318610",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wright Patterson AFB, OH

Sources for this page

Verify at the official NPI Registry.