Healthcare Provider Details

I. General information

NPI: 1043430523
Provider Name (Legal Business Name): KIMBERLY S HUNTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2065 STONERIDGE DR
CIRCLEVILLE OH
43113-8956
US

IV. Provider business mailing address

PO BOX 1769
PETERSBURG AK
99833-1769
US

V. Phone/Fax

Practice location:
  • Phone: 740-500-1391
  • Fax:
Mailing address:
  • Phone: 907-772-2020
  • Fax: 907-772-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number13496
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN.205081
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: