Provider Demographics
NPI:1154186419
Name:HOUGH, KIMBERLY (FNP-C)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:HOUGH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19512 POMPANO LN UNIT 107
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-6423
Mailing Address - Country:US
Mailing Address - Phone:509-628-6833
Mailing Address - Fax:
Practice Address - Street 1:32 EXECUTIVE PARK STE 150
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-4722
Practice Address - Country:US
Practice Address - Phone:949-723-0585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029009363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty