Provider Demographics
NPI:1326204892
Name:HENRICHS, KIMBERLY LYNETTE (MD)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LYNETTE
Last Name:HENRICHS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:LYNETTE
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1100 WILFORD HALL LOOP
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78236-5638
Mailing Address - Country:US
Mailing Address - Phone:210-292-4046
Mailing Address - Fax:
Practice Address - Street 1:333 N. SANTA ROSA STREET
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207
Practice Address - Country:US
Practice Address - Phone:210-704-2011
Practice Address - Fax:608-265-7957
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111666208000000X
WI56993-20208000000X
TXQ1163208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics