Provider Demographics
NPI:1497189260
Name:HINTON, KIMBERLY JOHNSTON (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JOHNSTON
Last Name:HINTON
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 N RAZORBACK RD
Mailing Address - Street 2:BARNHILL ARENA 117A
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-3954
Mailing Address - Country:US
Mailing Address - Phone:479-571-0629
Mailing Address - Fax:479-575-2471
Practice Address - Street 1:350 N RAZORBACK RD
Practice Address - Street 2:BARNHILL ARENA 117A
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-3954
Practice Address - Country:US
Practice Address - Phone:479-571-0629
Practice Address - Fax:479-575-2471
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21492255A2300X
TN17312255A2300X
AR7592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer