Provider Demographics
NPI:1467436816
Name:HEBERT, KIMBERLY L (PAC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:L
Last Name:HEBERT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 N RIDGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1227
Mailing Address - Country:US
Mailing Address - Phone:316-462-6200
Mailing Address - Fax:316-462-6201
Practice Address - Street 1:3730 N RIDGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1227
Practice Address - Country:US
Practice Address - Phone:316-462-6200
Practice Address - Fax:316-462-6201
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500674207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100364290EMedicaid
KS100364290EMedicaid
KS426852Medicare ID - Type Unspecified