Provider Demographics
NPI:1942850862
Name:HASTINGS, KIMBERLI MAE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLI
Middle Name:MAE
Last Name:HASTINGS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 199
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:SD
Mailing Address - Zip Code:57363-0199
Mailing Address - Country:US
Mailing Address - Phone:605-999-0643
Mailing Address - Fax:
Practice Address - Street 1:125 SD HWY 246
Practice Address - Street 2:
Practice Address - City:FORT THOMPSON
Practice Address - State:SD
Practice Address - Zip Code:57339
Practice Address - Country:US
Practice Address - Phone:605-245-2700
Practice Address - Fax:866-423-6811
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2477350163W00000X
SDCP001748363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse