Provider Demographics
NPI:1659596450
Name:HAVINS, KIMBERLY A (PMHNP-RN-FNP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:HAVINS
Suffix:
Gender:F
Credentials:PMHNP-RN-FNP-C
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:OTTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, FNP-C
Mailing Address - Street 1:1714 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-5011
Mailing Address - Country:US
Mailing Address - Phone:940-766-4482
Mailing Address - Fax:940-766-4487
Practice Address - Street 1:1714 10TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5011
Practice Address - Country:US
Practice Address - Phone:940-766-4482
Practice Address - Fax:940-766-4487
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX617471363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0367754-22OtherNP CERTIFICATION
8A3170Medicare ID - Type Unspecified