Provider Demographics
NPI:1407512007
Name:MANGES, KIMBERLY JO (DNP, APRN, AGACNP-BC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:JO
Last Name:MANGES
Suffix:
Gender:F
Credentials:DNP, APRN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#A1-5200
Mailing Address - Street 2:1100 NUUANU AVENUE
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96871
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:#A1-5200
Practice Address - Street 2:1100 NUUANU AVENUE
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96871
Practice Address - Country:US
Practice Address - Phone:202-509-5456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-3313207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine