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Individual

KIMBERLY D HAFEMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
113 COMANCHE RD, FORT MEADE, SD 57741-1002
(605) 745-2000
Mailing address
3011 AVENUE B, SCOTTSBLUFF, NE 69361-4372
(308) 632-2215

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1475
NE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
10025664300
NE
01
1475
STATE LICENSE
NE
Enumeration date
11/05/2009
Last updated
03/15/2024
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