Provider Demographics
NPI:1942793286
Name:HURLEY, KIMBERLY DANIELLE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DANIELLE
Last Name:HURLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:DANIELLE
Other - Last Name:MADISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1086 LOVELY LN
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-4231
Mailing Address - Country:US
Mailing Address - Phone:217-891-4359
Mailing Address - Fax:
Practice Address - Street 1:6844 INTERNATIONAL CENTER BLVD STE 500
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7159
Practice Address - Country:US
Practice Address - Phone:800-217-9289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician