Provider Demographics
NPI:1376176081
Name:COMBS, KACEY (APRN)
Entity Type:Individual
Prefix:
First Name:KACEY
Middle Name:
Last Name:COMBS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 BETIO PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-3101
Mailing Address - Country:US
Mailing Address - Phone:850-865-3685
Mailing Address - Fax:
Practice Address - Street 1:900 FORT STREET MALL STE 1040
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3701
Practice Address - Country:US
Practice Address - Phone:808-638-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-2873363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health