Provider Demographics
NPI:1528593142
Name:HUNTER, KIM N (BS)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:N
Last Name:HUNTER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:NICOLE
Other - Last Name:JERMANY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5036 STAGECOACH WAY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-2438
Mailing Address - Country:US
Mailing Address - Phone:214-664-0837
Mailing Address - Fax:
Practice Address - Street 1:9210 S WESTERN AVE STE A-21
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-4982
Practice Address - Country:US
Practice Address - Phone:214-664-0837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional