Provider Demographics
NPI:1013392869
Name:HUTCHINSON, KIMBERLY S (PHD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:HUTCHINSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MAPLEWOOD DR STE 1
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-6100
Mailing Address - Country:US
Mailing Address - Phone:337-533-8035
Mailing Address - Fax:337-625-6968
Practice Address - Street 1:2500 MAPLEWOOD DR STE 1
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-6100
Practice Address - Country:US
Practice Address - Phone:337-564-6240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9204103G00000X, 103T00000X, 103TC0700X, 103TR0400X
FL9204103T00000X
LA1330103T00000X, 103TC0700X, 103TR0400X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation