Provider Demographics
NPI:1003445958
Name:CARHUATANTA, KIMBERLY (DO PHD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CARHUATANTA
Suffix:
Gender:F
Credentials:DO PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-344-5555
Mailing Address - Fax:859-344-5552
Practice Address - Street 1:98 ELM ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-2048
Practice Address - Country:US
Practice Address - Phone:812-496-8775
Practice Address - Fax:812-537-5710
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02007463A207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program