Provider Demographics
NPI:1033398219
Name:STARKS, KIMBERLY S (AUD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:STARKS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:S
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-886-9370
Mailing Address - Fax:740-886-9374
Practice Address - Street 1:96 TOWNSHIP ROAD 369
Practice Address - Street 2:
Practice Address - City:PROCTORVILLE
Practice Address - State:OH
Practice Address - Zip Code:45669-9133
Practice Address - Country:US
Practice Address - Phone:740-886-9370
Practice Address - Fax:740-886-9374
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.01577231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH310917085190OtherOH MEDICAID CARESOURCE
P00711132OtherRAIL ROAD MEDICARE
OH000000259545OtherOH MEDICAID UNISON
WV3810011309Medicaid
OH0098592Medicaid
OHSM227141Medicare PIN