Active NPI
Kimberley Bevan
- Pharmacist
- Oconomowoc, WI
National Provider Identifier
1518384643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 10040-40
- Practice address
- 1284 East Summit Avenue
Suite 100
Oconomowoc, WI 53066 - Phone
- (262) 569-8204
- NPI assigned
- Mar 26, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 10040-40 | WI | Primary |
| Pharmacist | 183500000X | 03-2-14081 | OH |
Addresses
Primary practice location
1284 East Summit Avenue
Suite 100
Oconomowoc, WI 53066
Mailing address
1284 East Summit Avenue
Suite 100
Oconomowoc, WI 53066
Phone (262) 569-8204
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
| License | State | Type | Specialty |
|---|---|---|---|
| 10040-40 | WI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1395792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395792000000",
"number": "1518384643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1284 EAST SUMMIT AVENUE",
"address_2": "SUITE 100",
"city": "OCONOMOWOC",
"state": "WI",
"postal_code": "53066",
"telephone_number": "262-569-8204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1284 EAST SUMMIT AVENUE",
"address_2": "SUITE 100",
"city": "OCONOMOWOC",
"state": "WI",
"postal_code": "53066",
"telephone_number": "262-569-8204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEVAN",
"first_name": "KIMBERLEY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-03-26",
"last_updated": "2014-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "10040-40",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OH",
"license": "03-2-14081",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oconomowoc, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.