Provider Demographics
NPI:1396006417
Name:HODGES, KIMBERLY
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:HODGES
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 1:1475 VISTA DEL RANCHO PKWY
Mailing Address - Street 2:APT212
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-6335
Mailing Address - Country:US
Mailing Address - Phone:775-688-9360
Mailing Address - Fax:
Practice Address - Street 1:2300 HARVARD WAY
Practice Address - Street 2:105B
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-4002
Practice Address - Country:US
Practice Address - Phone:775-420-5396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst