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General NPI Number Information
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NPI Number | 1891478996
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Entity Type | Organization
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Legal Business Name | HEALTHY HAVEN HEALTHCARE
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Dates
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Enumeration Date | 08/08/2023
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Last Update Date | 03/13/2026
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Provider Practice Location Address
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Address Line | 1508 SANTA FE DR STE 103
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City | WEATHERFORD
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State | TX
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Zip | 76086-5859
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Country | US
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Telephone | 817-242-5789
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Fax | 888-752-9156
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Provider Business Mailing Address
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Address Line | 201 SOUTHVIEW DR
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City | HUDSON OAKS
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State | TX
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Zip | 76087-8232
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Country | US
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Telephone | 863-528-5627
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Fax |
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Authorized Official
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Title or Position | OWNER/FNP-C
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Name | KIMBERLY NICHOLE SCOTT
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Credential | FNP-C
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Telephone | 863-528-5627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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