Provider Demographics
NPI:1548423833
Name:HEBERT, KIANDRA K (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIANDRA
Middle Name:K
Last Name:HEBERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 REAGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-8002
Mailing Address - Country:US
Mailing Address - Phone:619-993-3710
Mailing Address - Fax:855-553-6013
Practice Address - Street 1:131 NAHM ST STE 8
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4362
Practice Address - Country:US
Practice Address - Phone:270-366-7918
Practice Address - Fax:855-553-6013
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2019-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY241891103T00000X
CA24703103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical