Provider Demographics
NPI:1073548863
Name:HOOD, KIMBERLY P (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:P
Last Name:HOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 REDSTONE AVE W
Mailing Address - Street 2:SUITE 470
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-6428
Mailing Address - Country:US
Mailing Address - Phone:850-689-2223
Mailing Address - Fax:850-689-2204
Practice Address - Street 1:550 REDSTONE AVE W
Practice Address - Street 2:SUITE 470
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-6428
Practice Address - Country:US
Practice Address - Phone:850-689-2223
Practice Address - Fax:850-689-2204
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87709207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267100000Medicaid
FL450517213OtherFED TAX IDENTIFICATION
FL267100000Medicaid
FL450517213OtherFED TAX IDENTIFICATION