Active NPI
Kimberly Kay Edsen, PHARMD
- Pharmacist
- Clive, IA
National Provider Identifier
1164704672
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 19801
- Practice address
- 15601 Hickman Rd
Clive, IA 50325-7985 - Phone
- (515) 987-6807
- Fax
- (515) 987-6812
- NPI assigned
- Sep 12, 2011
- Last updated
- Sep 12, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 19801 | IA | Primary |
Addresses
Primary practice location
15601 Hickman Rd
Clive, IA 50325-7985
Mailing address
20932 S Ave
Dallas Center, IA 50063-8408
Phone (515) 992-3346
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19801 | IA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315785600000",
"number": "1164704672",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20932 S AVE",
"city": "DALLAS CENTER",
"state": "IA",
"postal_code": "500638408",
"telephone_number": "515-992-3346"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15601 HICKMAN RD",
"city": "CLIVE",
"state": "IA",
"postal_code": "503257985",
"telephone_number": "515-987-6807",
"fax_number": "515-987-6812"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDSEN",
"first_name": "KIMBERLY",
"middle_name": "KAY",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-09-12",
"last_updated": "2011-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IA",
"license": "19801",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clive, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.