Provider Demographics
NPI:1083242739
Name:HUNT, KIMBERLY ELLEN
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ELLEN
Last Name:HUNT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 SALEM CAVE RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:OH
Mailing Address - Zip Code:45613-9770
Mailing Address - Country:US
Mailing Address - Phone:740-285-9093
Mailing Address - Fax:
Practice Address - Street 1:377 HICKSON RUN RD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9616
Practice Address - Country:US
Practice Address - Phone:740-285-9093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0203681Medicaid