Provider Demographics
NPI:1578236964
Name:HIBBLER, KAKAWONDA T (CFNP)
Entity Type:Individual
Prefix:
First Name:KAKAWONDA
Middle Name:T
Last Name:HIBBLER
Suffix:
Gender:F
Credentials:CFNP
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Other - First Name:
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Mailing Address - Street 1:640 SUNFLOWER AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:MS
Mailing Address - Zip Code:38751-2687
Mailing Address - Country:US
Mailing Address - Phone:662-207-8492
Mailing Address - Fax:
Practice Address - Street 1:702 HIGHWAY 82 E
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:MS
Practice Address - Zip Code:38751-2322
Practice Address - Country:US
Practice Address - Phone:662-207-8492
Practice Address - Fax:662-887-7042
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2022-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MSHIBB-HIF5DC207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine