Provider Demographics
NPI:1477685915
Name:HAMMOND, KIMBERELY SUE (CSA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERELY
Middle Name:SUE
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-4220
Mailing Address - Country:US
Mailing Address - Phone:817-301-3057
Mailing Address - Fax:817-399-1972
Practice Address - Street 1:2303 HOLLY DR
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-4220
Practice Address - Country:US
Practice Address - Phone:817-301-3057
Practice Address - Fax:817-399-1972
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist