Provider Demographics
NPI:1437320819
Name:HORNBAKER, KIMBERLY DAWN (APRN)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:DAWN
Last Name:HORNBAKER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:DAWN
Other - Last Name:CANFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2135 N COLLECTIVE LN
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3560
Mailing Address - Country:US
Mailing Address - Phone:316-261-3221
Mailing Address - Fax:316-261-3298
Practice Address - Street 1:2135 N COLLECTIVE LN
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3560
Practice Address - Country:US
Practice Address - Phone:316-261-3221
Practice Address - Fax:316-261-3298
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-92014163W00000X
KS53-46179363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse