Individual provider Active NPI

Kimberly Cole, NP

  • Pediatric Nurse Practitioner
  • Modesto, CA
National Provider Identifier
1780056481
Registry record updated Apr 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
95033625 Issued in CA
Practice address
1510 Florida Ave
Modesto, CA 95350-4437
Phone
(209) 722-4842
NPI assigned
Oct 21, 2015
Last updated
Apr 8, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95033625CAMDPediatric Nurse Practitioner
71005881BINMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Meridian Health Services Corp. CurrentSince Jun 16, 2017 Accepting new patients
Meridian Health Services Corp CurrentSince Jun 16, 2017 Accepting new patients

Locations

205 N Tillotson Ave
Muncie, IN 47304
Phone (765) 288-1995

240 N Tillotson Ave
Muncie, IN 47304

Interoperability endpoints

  • Direct secure messaging: 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.

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

Verify at the official NPI Registry.