Provider Demographics
NPI:1043938715
Name:HOGLUND, KIMBERLEY (RN)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:
Last Name:HOGLUND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:KIMBERLEY
Other - Middle Name:
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2515 MATHEWS ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-2008
Mailing Address - Country:US
Mailing Address - Phone:510-504-8514
Mailing Address - Fax:
Practice Address - Street 1:2515 MATHEWS ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-2008
Practice Address - Country:US
Practice Address - Phone:510-504-8514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN532762163W00000X
CARN532761163WC0400X, 163WC1600X, 163WH0200X, 163WM1400X, 163WN1003X, 163WP0000X
CARN531761163WG0000X
CARN5312761163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff DevelopmentGroup - Single Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)Group - Single Specialty
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN532761Medicaid