Provider Demographics
NPI:1043522170
Name:HALAQUIST, KIM EVELYN (FNP)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:EVELYN
Last Name:HALAQUIST
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2 TITUS PLACE
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:NY
Mailing Address - Zip Code:13856-1455
Mailing Address - Country:US
Mailing Address - Phone:607-865-2400
Mailing Address - Fax:607-865-7305
Practice Address - Street 1:2 TITUS PLACE
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:NY
Practice Address - Zip Code:13856-1455
Practice Address - Country:US
Practice Address - Phone:607-865-2400
Practice Address - Fax:607-865-7305
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336402364SF0001X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health