| Doctor Name: | MRS. KIMBERLY HAINES |
| NPI Number: | 1194185009 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CNP |
| License Number: | CP001044 |
| Business Practice Address: | 640 E Sioux Ave Pierre, SD - 575013300 |
| Business Phone Number: | 6059455560 |
| Business Fax Number: | |
| Mailing Address: | 1610 Skerrols St, Apt E1 FORT PIERRE |
| State: | SD |
| Postal Code: | 575322359 |
| Phone Number: | 6057704571 |
| Fax Number: | |
| NPI Enumeration Date: | 03/04/2016 |
| NPI Last Update Date: | 03/04/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | CP001044 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |