Healthcare Provider Details

I. General information

NPI: 1629931548
Provider Name (Legal Business Name): KIMBERLY A HUERTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2429 BRIARWOOD LN
SYCAMORE IL
60178-2805
US

IV. Provider business mailing address

2429 BRIARWOOD LN
SYCAMORE IL
60178-2805
US

V. Phone/Fax

Practice location:
  • Phone: 815-491-9540
  • Fax:
Mailing address:
  • Phone: 815-491-9540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: