Provider Demographics
NPI:1972822047
Name:KUKLIS, KIMBERLY (APRN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:KUKLIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 ALA MOANA BLVD STE 1001
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5408
Mailing Address - Country:US
Mailing Address - Phone:808-469-4900
Mailing Address - Fax:808-536-7315
Practice Address - Street 1:155 W KAWILI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5098
Practice Address - Country:US
Practice Address - Phone:808-798-0196
Practice Address - Fax:808-536-7315
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-66187163W00000X
HIAPRN-2395363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHH2711Medicaid
AKMS0272Medicaid
AKCMG799Medicaid
AKNA3799Medicaid
AKHC2563Medicaid
AK027010Medicare PIN