Provider Demographics
NPI:1326885971
Name:HINKLE, KIMBERLY LEEANN (PRSS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LEEANN
Last Name:HINKLE
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 CHESAPEAKE ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-1734
Mailing Address - Country:US
Mailing Address - Phone:304-730-2790
Mailing Address - Fax:
Practice Address - Street 1:2444 COLLIS AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-1235
Practice Address - Country:US
Practice Address - Phone:304-948-5004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24-984175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist