Active NPI
Kimberly Cole, NP
- Pediatric Nurse Practitioner
- Modesto, CA
National Provider Identifier
1780056481
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 95033625
- Practice address
- 1510 Florida Ave
Modesto, CA 95350-4437 - Phone
- (209) 722-4842
- NPI assigned
- Oct 21, 2015
- Last updated
- Apr 8, 2025
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 71005881B | IN | |
| Pediatric Nurse Practitioner | 363LP0200X | 95033625 | CA | Primary |
Addresses
Primary practice location
1510 Florida Ave
Modesto, CA 95350-4437
Mailing address
240 N Tillotson Ave
Muncie, IN 47304-3988
Phone (765) 288-1928
Other practice location 1
205 N Tillotson Ave
Muncie, IN 47304-3900
Phone (765) 288-1995
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95033625 | CA | MD | Pediatric Nurse Practitioner |
| 71005881B | IN | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Meridian Health Services Corp. | Current | Accepting new patients | |
| Meridian Health Services Corp | Current | Accepting new patients |
Locations
205 N Tillotson Ave
Muncie, IN 47304
Phone (765) 288-1995
240 N Tillotson Ave
Muncie, IN 47304
Interoperability endpoints
- kimberly.robinson@577908282753028.direct.elationemr.com
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Muncie, IN
- NPI 1992755490
-
- Federally Qualified Health Center (FQHC)
- Montpelier, IN
- NPI 1417838574
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1744070400000",
"number": "1780056481",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "240 N TILLOTSON AVE",
"city": "MUNCIE",
"state": "IN",
"postal_code": "473043988",
"telephone_number": "765-288-1928",
"fax_number": "765-741-0335"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1510 FLORIDA AVE",
"city": "MODESTO",
"state": "CA",
"postal_code": "953504437",
"telephone_number": "209-722-4842"
}
],
"practiceLocations": [
{
"address_1": "205 N Tillotson Ave",
"address_purpose": "LOCATION",
"city": "Muncie",
"state": "IN",
"postal_code": "473043900",
"country_code": "US",
"telephone_number": "765-288-1995",
"fax_number": "765-289-7512",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "COLE",
"first_name": "KIMBERLY",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-10-21",
"last_updated": "2025-04-08",
"certification_date": "2025-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "IN",
"license": "71005881B",
"primary": false
},
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "CA",
"license": "95033625",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.