MEDICARE: KIMBERLY HADLEY CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	10845	OH
2	363LF0000X	Family Nurse Practitioner	A-107310	IA
3	363LF0000X	Family Nurse Practitioner	2011008644	MO

General Provider Information

NPI Number	:	1619108768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY HADLEY CNP

Provider Business Mailing Address
First Line	:	10460 ANZEIGER AVE
Second Line	:
City	:	FRONTENAC
State	:	MO
Zip	:	63131-2753
Country	:	US
Telephone Number	:	641-781-0168
Fax Number	:

Provider Business Practice Location Address
First Line	:	7909 HIGHWAY N
Second Line	:
City	:	DARDENNE PRAIRIE
State	:	MO
Zip	:	63368-7382
Country	:	US
Telephone Number	:	636-625-1560
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2009
Last Update Date	:	08/31/2011

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