Provider Demographics
NPI:1528614047
Name:HIZER, KIMBERLY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:HIZER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 ABBEY RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:IN
Mailing Address - Zip Code:46167-8994
Mailing Address - Country:US
Mailing Address - Phone:317-554-7419
Mailing Address - Fax:
Practice Address - Street 1:7230 ARBUCKLE CMNS STE 203
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-1795
Practice Address - Country:US
Practice Address - Phone:317-554-7419
Practice Address - Fax:812-559-9192
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28210176A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300032553Medicaid