Kimberly Bousema, PA is a
Physician Assistant based in Rensselaer, Indiana. Kimberly Bousema is licensed to practice in Indiana (license number 10004742A) and her current practice location is
1103 E Grace St, Rensselaer, Indiana. She can be reached at her office (for appointments etc.) via phone at
(219) 866-0411.
NPI number for Kimberly Bousema is 1629819826 and her current mailing address is Po Box 781076, Detroit, Michigan. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1629819826.
Provider's Profile
| Full Name | Kimberly Bousema |
|---|
| Gender | Female |
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| Speciality | Physician Assistant |
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| Location | 1103 E Grace St, Rensselaer, Indiana |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1629819826
- Provider Enumeration Date: 06/03/2024
- Last Update Date: 03/07/2025
Medical Identifiers
Medical identifiers for Kimberly Bousema such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1629819826 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363A00000X | Physician Assistant | 10004742A (Indiana) | Primary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kimberly Bousema is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Kimberly Bousema, PA
Po Box 781076,
Detroit, MI 48278-1076
Ph: (317) 528-4800 | Kimberly Bousema, PA
1103 E Grace St,
Rensselaer, IN 47978-3251
Ph: (219) 866-0411 |
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