Provider Demographics
NPI:1407400708
Name:HYATT, KIMBERLY RHAE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RHAE
Last Name:HYATT
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 1:6750 AVERY MUIRFIELD DR STE A1
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1228
Mailing Address - Country:US
Mailing Address - Phone:614-407-4268
Mailing Address - Fax:614-793-8431
Practice Address - Street 1:6750 AVERY MUIRFIELD DR STE A1
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1228
Practice Address - Country:US
Practice Address - Phone:614-407-4268
Practice Address - Fax:614-793-8431
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025047363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily