Healthcare Provider Details

I. General information

NPI: 1881086759
Provider Name (Legal Business Name): KIMBERLY LYNN HUFFMAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY LYNN YERKES

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 HADLEY RD STE 101
MOORESVILLE IN
46158-1884
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 317-781-7344
  • Fax: 317-834-3779
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71005387A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: