Kimberly Dawn Sides, LPN

Individual provider Active NPI Licensed Practical Nurse · Bridgeport, NE

NPI 1295007151 · NPPES record last updated Feb 7, 2012

Key facts

NPI
1295007151
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
23306 (NE)
Practice address
9738 US Highway 385
Bridgeport, NE 69336-2735
Phone
(308) 778-6407
NPI assigned
Feb 7, 2012
Sex
Female
Sole proprietor
No

Medicare participation

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

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
23306NEMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 23306 NE Yes

Addresses

Primary practice location

9738 US Highway 385
Bridgeport, NE 69336-2735

Mailing address

9738 US Highway 385
Bridgeport, NE 69336-2735
Phone (308) 778-6407

Other providers in Bridgeport, NE

All providers in Bridgeport, NE · Licensed Practical Nurse in Nebraska

Sources for this page

Verify at the official NPI Registry.