Provider Demographics
NPI:1255216552
Name:KIMMINAU, PAMELA KAY (LPN)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:KAY
Last Name:KIMMINAU
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:KAY
Other - Last Name:ISAAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1316 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WOOD RIVER
Mailing Address - State:NE
Mailing Address - Zip Code:68883-9126
Mailing Address - Country:US
Mailing Address - Phone:308-383-7922
Mailing Address - Fax:
Practice Address - Street 1:13800 W WOOD RIVER RD
Practice Address - Street 2:
Practice Address - City:WOOD RIVER
Practice Address - State:NE
Practice Address - Zip Code:68883-9456
Practice Address - Country:US
Practice Address - Phone:308-583-2249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10726164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse