Active NPI
Kimberly J. Gates, PA-C
- Physician Assistant
- Omaha, NE
National Provider Identifier
1588749964
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 848
- Practice address
- 10862 W Dodge Rd
Omaha, NE 68154-2609 - Phone
- (402) 671-0396
- NPI assigned
- Oct 26, 2006
- Last updated
- Oct 31, 2023
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 848 | NE | Primary |
Addresses
Primary practice location
10862 W Dodge Rd
Omaha, NE 68154-2609
Mailing address
1404 N 189TH St
Elkhorn, NE 68022-4486
Phone (402) 650-5554
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38529 | Other | NE | BCBS OF NEBRASKA |
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 848 | NE | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698710400000",
"number": "1588749964",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1404 N 189TH ST",
"city": "ELKHORN",
"state": "NE",
"postal_code": "680224486",
"telephone_number": "402-650-5554"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10862 W DODGE RD",
"city": "OMAHA",
"state": "NE",
"postal_code": "681542609",
"telephone_number": "402-671-0396"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GATES",
"first_name": "KIMBERLY",
"middle_name": "J.",
"name_prefix": "Ms.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-26",
"last_updated": "2023-10-31",
"certification_date": "2023-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NE",
"license": "848",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF NEBRASKA",
"identifier": "38529",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.