Provider Demographics
NPI:1104847458
Name:HINCKS, KERRY L (DO)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:L
Last Name:HINCKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8810 HIGHWAY 6 STE 100
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-7104
Mailing Address - Country:US
Mailing Address - Phone:713-486-1200
Mailing Address - Fax:281-778-5345
Practice Address - Street 1:8810 HIGHWAY 6 STE 100
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-7104
Practice Address - Country:US
Practice Address - Phone:713-486-1200
Practice Address - Fax:281-778-5345
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-047892207Q00000X
TXQ7205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036116570Medicaid
ILCA4079OtherRR GROUP #
ILP00433545OtherRR INDIVIDUAL #
IL809840OtherMEDICARE GROUP #