Provider Demographics
NPI:1861839425
Name:HATTON, KIMBERLY LAVELLE (NP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:LAVELLE
Last Name:HATTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:LAVELLE
Other - Last Name:BURICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 1139
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1139
Mailing Address - Country:US
Mailing Address - Phone:661-371-2796
Mailing Address - Fax:661-438-1746
Practice Address - Street 1:3008 SILLECT AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-6340
Practice Address - Country:US
Practice Address - Phone:661-432-7851
Practice Address - Fax:661-432-7852
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP11269363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner