Individual provider Active NPI

Kimberly Wells

  • School Registered Nurse
  • Broken Bow, NE
National Provider Identifier
1104537489
Registry record updated Dec 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
School Registered NurseTaxonomy code 163WS0200X
License
55759 Issued in NE
Practice address
323 N 7TH Ave
Broken Bow, NE 68822-1718
Phone
(308) 872-6821
NPI assigned
Dec 8, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
School Registered Nurse 163WS0200X 55759 NE Primary

Addresses

Primary practice location

323 N 7TH Ave
Broken Bow, NE 68822-1718

Mailing address

323 N 7TH Ave
Broken Bow, NE 68822-1718
Phone (308) 872-6821

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
55759NEMDSchool Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Broken Bow Public Schools County of Custer School District 25 CurrentSince Dec 13, 2022 Accepting new patients

Locations

323 N 7th Ave
Broken Bow, NE 68822
Phone (308) 872-2475

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1670457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670457600000",
    "number": "1104537489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "323 N 7TH AVE",
            "city": "BROKEN BOW",
            "state": "NE",
            "postal_code": "688221718",
            "telephone_number": "308-872-6821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 N 7TH AVE",
            "city": "BROKEN BOW",
            "state": "NE",
            "postal_code": "688221718",
            "telephone_number": "308-872-6821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLS",
        "first_name": "KIMBERLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-08",
        "last_updated": "2022-12-08",
        "certification_date": "2022-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WS0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, School",
            "state": "NE",
            "license": "55759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broken Bow, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.