Provider Demographics
NPI:1447686241
Name:BALDWIN, KIMBERLY A (APN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:MATTEI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 LIBERTY BLVD
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-2384
Mailing Address - Country:US
Mailing Address - Phone:815-520-1541
Mailing Address - Fax:
Practice Address - Street 1:210 LIBERTY BLVD
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-2384
Practice Address - Country:US
Practice Address - Phone:815-520-1541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010699363LP0808X
IL209.010699364SP0809X
IL277000782364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health