Provider Demographics
NPI:1447357199
Name:PFLUGHAUPT, KIMBERLY KAYE (FNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAYE
Last Name:PFLUGHAUPT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 NEWPORTE BLVD
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-2479
Mailing Address - Country:US
Mailing Address - Phone:219-575-6244
Mailing Address - Fax:219-380-0757
Practice Address - Street 1:3777 N FRONTAGE RD STE 500
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7697
Practice Address - Country:US
Practice Address - Phone:219-809-2889
Practice Address - Fax:219-878-0711
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000513063OtherANTHEM, BCBS
IN200840440Medicaid
IN200840440Medicaid