Provider Demographics
NPI:1366513590
Name:HAMILTON, KIM LYNN (P A)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:LYNN
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:P A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23144 WESTHEIMER PKWY
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3603
Mailing Address - Country:US
Mailing Address - Phone:281-392-5005
Mailing Address - Fax:281-392-5052
Practice Address - Street 1:11700 WESTHEIMER RD STE J
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-6884
Practice Address - Country:US
Practice Address - Phone:346-575-0067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04990363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA04990OtherLICENSE NUMBER
TXQ77762Medicare UPIN
TXPA04990OtherLICENSE NUMBER