Healthcare Provider Details

I. General information

NPI: 1649184201
Provider Name (Legal Business Name): KIMBERLY HUST AWESOME RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLY HUST ELSON RN

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 DUSTY LN
CAVE CITY AR
72521-9268
US

IV. Provider business mailing address

350 DUSTY LN
CAVE CITY AR
72521-9268
US

V. Phone/Fax

Practice location:
  • Phone: 870-613-5362
  • Fax: --
Mailing address:
  • Phone: 870-613-5362
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR085989
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: