Provider Demographics
NPI:1326204892
Name:HENRICHS, KIMBERLY LYNETTE (MD)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LYNETTE
Last Name:HENRICHS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:LYNETTE
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5282 MEDICAL DR STE 310
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6044
Mailing Address - Country:US
Mailing Address - Phone:210-614-8687
Mailing Address - Fax:210-614-7529
Practice Address - Street 1:5282 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4849
Practice Address - Country:US
Practice Address - Phone:210-614-8687
Practice Address - Fax:210-614-7529
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ1163208000000X, 208000000X
WI56993-20208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics