Provider Demographics
NPI:1013563907
Name:HAZZARD, KIM
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:HAZZARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 BEAVER MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NY
Mailing Address - Zip Code:13832
Mailing Address - Country:US
Mailing Address - Phone:315-837-4934
Mailing Address - Fax:
Practice Address - Street 1:246 BEAVER MEADOW RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NY
Practice Address - Zip Code:13832
Practice Address - Country:US
Practice Address - Phone:315-837-4934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider