Provider Demographics
NPI:1922638758
Name:HERNANDEZ, KIMBERLY DIANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:DIANNE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5924 ROYAL LN STE 258
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-8801
Mailing Address - Country:US
Mailing Address - Phone:214-865-9449
Mailing Address - Fax:972-474-9043
Practice Address - Street 1:6750 HILLCREST PLAZA DR STE 206
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1438
Practice Address - Country:US
Practice Address - Phone:214-865-9449
Practice Address - Fax:972-474-9043
Is Sole Proprietor?:No
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38374103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling