Provider Demographics
NPI:1871806976
Name:LABREE, KIMBERLY BERGER (ARNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:BERGER
Last Name:LABREE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 13925
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4030
Mailing Address - Country:US
Mailing Address - Phone:904-376-3769
Mailing Address - Fax:904-202-7377
Practice Address - Street 1:836 PRUDENTIAL DR FL 6
Practice Address - Street 2:ATTN: CREDENTIALING DEPARTMENT
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8334
Practice Address - Country:US
Practice Address - Phone:904-202-7300
Practice Address - Fax:904-202-7377
Is Sole Proprietor?:No
Enumeration Date:2010-07-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30 305443363LA2200X
VA0024170030363LA2200X
FLARNP9405150363LA2200X
VA0001236485163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIN PROCESSOtherRAILROAD MEDICARE
FL015141600Medicaid
FLIN PROCESSOtherRAILROAD MEDICARE