Provider Demographics
NPI:1619265477
Name:HUDGINS, KIMBERLEE JOANNA
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:JOANNA
Last Name:HUDGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6204 HILLSIDE RD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-7196
Mailing Address - Country:US
Mailing Address - Phone:806-355-7633
Mailing Address - Fax:806-355-7644
Practice Address - Street 1:6204 HILLSIDE RD
Practice Address - Street 2:SUITE 1000
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-7196
Practice Address - Country:US
Practice Address - Phone:806-355-7633
Practice Address - Fax:806-355-7644
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1208809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149984001Medicaid
TX207164901Medicaid
TX149984001Medicaid
TX676535Medicare PIN