Provider Demographics
NPI:1801414628
Name:HANLEY, KIMBERLY NOELLE (APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:NOELLE
Last Name:HANLEY
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 W GORE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6016
Mailing Address - Country:US
Mailing Address - Phone:580-699-8383
Mailing Address - Fax:580-699-8381
Practice Address - Street 1:4411 W GORE BLVD STE A
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6016
Practice Address - Country:US
Practice Address - Phone:580-699-8383
Practice Address - Fax:580-699-8381
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK110373363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily