Provider Demographics
NPI:1437474897
Name:HAUGABOOK, KIMBERLY CARNELLA (RN,BSN,MSN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:CARNELLA
Last Name:HAUGABOOK
Suffix:
Gender:F
Credentials:RN,BSN,MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-2313
Mailing Address - Country:US
Mailing Address - Phone:513-887-2000
Mailing Address - Fax:513-887-2300
Practice Address - Street 1:1101 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-2313
Practice Address - Country:US
Practice Address - Phone:513-887-2000
Practice Address - Fax:513-887-2300
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.12166363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH277048OtherMEDICARE PTAN
OHP02361925OtherRRMEDICARE PTAN
OH0061614Medicaid