Provider Demographics
NPI:1184719585
Name:GAYHEART, KIMBERLY RENE (CFNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RENE
Last Name:GAYHEART
Suffix:
Gender:F
Credentials:CFNP
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 1988
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702
Mailing Address - Country:US
Mailing Address - Phone:606-439-1300
Mailing Address - Fax:606-439-1400
Practice Address - Street 1:145 CITIZENS LANE
Practice Address - Street 2:SUITE B
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701
Practice Address - Country:US
Practice Address - Phone:606-439-1300
Practice Address - Fax:606-439-1400
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4915P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100005420Medicaid
KY0984405Medicare PIN
KY183942Medicare Oscar/Certification
KY0776315Medicare PIN
KYQ79370Medicare UPIN
KY7100005420Medicaid
KY183947Medicare Oscar/Certification
KY00051008Medicare PIN