=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649184201
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY HUST AWESOME RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2026
-----------------------------------------------------
Last Update Date | 09/30/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 DUSTY LN
-----------------------------------------------------
City | CAVE CITY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72521-9268
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-613-5362
-----------------------------------------------------
Fax | --
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 350 DUSTY LN
-----------------------------------------------------
City | CAVE CITY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72521-9268
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-613-5362
-----------------------------------------------------
Fax | --
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WH0200X
-----------------------------------------------------
Taxonomy Name | Home Health Registered Nurse
-----------------------------------------------------
License Number | R085989
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------