Provider Demographics
NPI:1083976039
Name:HYMAN, KIMBERLY LASHAWN
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:LASHAWN
Last Name:HYMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6840 NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4817
Mailing Address - Country:US
Mailing Address - Phone:301-326-4607
Mailing Address - Fax:
Practice Address - Street 1:6840 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-4817
Practice Address - Country:US
Practice Address - Phone:301-326-4607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNA00604032374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide