Provider Demographics
NPI:1265002067
Name:HATCH, KIMBERLY
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:HATCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:HATCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MI
Mailing Address - Zip Code:49241-0263
Mailing Address - Country:US
Mailing Address - Phone:151-789-0600
Mailing Address - Fax:
Practice Address - Street 1:7549 MOSCOW RD
Practice Address - Street 2:
Practice Address - City:HORTON
Practice Address - State:MI
Practice Address - Zip Code:49246-9301
Practice Address - Country:US
Practice Address - Phone:517-740-7361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI15-4756-87OtherAUTO INSURANCE-PIP
MI2603454090OtherAUTO INSURANCE- PIP