Provider Demographics
NPI:1699774422
Name:HANSEN, KIMBERLY ANNE (RN, CFNP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANNE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:RN, CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MIDWESTERN PKWY E
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-2302
Mailing Address - Country:US
Mailing Address - Phone:940-763-7835
Mailing Address - Fax:940-766-8711
Practice Address - Street 1:501 MIDWESTERN PKWY E
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76302-2302
Practice Address - Country:US
Practice Address - Phone:940-763-7835
Practice Address - Fax:940-766-8711
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX570268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1530834-01Medicaid
TXS0133086OtherDPS
TXMH1075325OtherDEA
TX1530834-01Medicaid
TX87966HMedicare PIN