Kimberley R Fantasia, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP081842 Issued in ME

Practice address

200 Kennedy Memorial Dr
Waterville, ME 04901-4526

Phone

(207) 681-3000

NPI assigned

Apr 17, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Nurse Practitioner

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gulfside Palliative Care, LLCGroup PAC ID 3678611837, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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

• Gulfside Palliative Care, LLC

  • Case Manager/Care Coordinator
  • Zephyrhills, FL
  • NPI 1750531489
  Medicare reassignment Care Compare group NPD
• Nautilus Health Care Group LLC

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Melbourne, FL
  • NPI 1912013558
  Medicare reassignment NPD
• Nautilus Health Care Group, LLC

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Kokomo, IN
  • NPI 1013234699
  NPD
• Advanced Wound Systems LLC

  • Durable Medical Equipment & Medical Supplies
  • St Petersburg, FL
  • NPI 1508054271
  NPD (past)
• Gulfside Hospice, Inc.

  • Community Based Hospice Care Agency
  • Land O' Lakes, FL
  • NPI 1144328881
  NPD (past)

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283385600000",
    "number": "1154547479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 KENNEDY MEMORIAL DR",
            "city": "WATERVILLE",
            "state": "ME",
            "postal_code": "049014526",
            "telephone_number": "207-681-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 KENNEDY MEMORIAL DR",
            "city": "WATERVILLE",
            "state": "ME",
            "postal_code": "049014526",
            "telephone_number": "207-681-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANTASIA",
        "first_name": "KIMBERLEY",
        "middle_name": "R",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-17",
        "last_updated": "2010-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ME",
            "license": "R051730",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ME",
            "license": "AP081842",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Christopher Evans, LCPC
• Amy L Everett, RNFA
• Eye Center of Central Maine
• Amie Fagan, PMHNP
• Family Medicine Associates of Waterville PA
• Terrie Farris, HIS
• Christina Marie Fasse, PSY.D.
• Linda A Fay, M.D.
• Caroline W Feely, LCSW
• Gary C. Ferguson, DMD, MS

• Family Nurse Practitioner in Waterville, ME
• Providers in Waterville, ME by specialty
• Family Nurse Practitioner in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.