NPIMap

Individual provider Active NPI

Kimberly J Dierks, P.A.-C

  • Physician Assistant
  • Omaha, NE
National Provider Identifier
1750374666
Registry record updated Jul 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1108 Issued in NE
Practice address
139 S 40TH St
Omaha, NE 68131-3003
Phone
(402) 595-3939
Fax
(402) 595-3898
NPI assigned
Aug 25, 2005
Last updated
Jul 23, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 001733 IA
Physician Assistant 363A00000X 1108 NE Primary

Addresses

Primary practice location

139 S 40TH St
Omaha, NE 68131-3003

Mailing address

16901 Lakeside Hills CT
Omaha, NE 68130-2318
Phone (402) 717-3769

Other practice location 1

16901 Lakeside Hills Ct
Omaha, NE 68130-2318
Phone (402) 717-3769

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE, IA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040428001373 NE Practitioner - Physician Assistant 3274520507 Reassigns benefits to 2 organizations
I20061205000045 IA Practitioner - Physician Assistant 3274520507 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
110658NEMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Montgomery County Memorial Hospital Physician Assistant CurrentSince Oct 10, 2012 Accepting new patients
Clarinda Regional Health Center CurrentSince Oct 15, 2019 Accepting new patients
Montgomery County Memorial Hospital Current Accepting new patients
Montgomery County Memorial Hospital CurrentSince Oct 10, 2012 Accepting new patients
Alegent Health Quick Care LLC Physician Assistant Past Accepting new patients
Emergency Physicians of Eastern Nebraska, PC Past Accepting new patients
The Nebraska Medical Center Past Accepting new patients
Box Butte General Hospital Past Accepting new patients

Locations

220 Essie Davison Dr
Clarinda, IA 51632
Phone (712) 542-8330

2301 Eastern Ave
Red Oak, IA 51566
Phone (712) 623-7270

Organizations & group practices 11

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": "1124928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784764800000",
    "number": "1750374666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16901 LAKESIDE HILLS CT",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681302318",
            "telephone_number": "402-717-3769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 S 40TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681313003",
            "telephone_number": "402-595-3939",
            "fax_number": "402-595-3898"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16901 Lakeside Hills Ct",
            "address_purpose": "LOCATION",
            "city": "Omaha",
            "state": "NE",
            "postal_code": "681302318",
            "country_code": "US",
            "telephone_number": "402-717-3769",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIERKS",
        "first_name": "KIMBERLY",
        "middle_name": "J",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-25",
        "last_updated": "2026-07-23",
        "certification_date": "2026-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "001733",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "1108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.