Provider Demographics
NPI:1902016157
Name:HALL, KIMBERLY HARGIS (NBCT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:HARGIS
Last Name:HALL
Suffix:
Gender:F
Credentials:NBCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 LOWER HATCHER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:KY
Mailing Address - Zip Code:40380-7149
Mailing Address - Country:US
Mailing Address - Phone:859-585-0061
Mailing Address - Fax:859-745-1304
Practice Address - Street 1:1630 LOWER HATCHER CREEK RD
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:KY
Practice Address - Zip Code:40380-7149
Practice Address - Country:US
Practice Address - Phone:859-585-0061
Practice Address - Fax:859-745-1304
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1648OtherPROVIDER NUMBER