Provider Demographics
NPI:1013392869
Name:HUTCHINSON, KIMBERLY S (PHD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:HUTCHINSON
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:PO BOX 100166
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33910-0166
Mailing Address - Country:US
Mailing Address - Phone:239-295-6564
Mailing Address - Fax:888-801-3850
Practice Address - Street 1:710 OAKFIELD DR STE 252
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4924
Practice Address - Country:US
Practice Address - Phone:239-295-6564
Practice Address - Fax:888-801-3850
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1330103TC0700X, 103T00000X, 103TR0400X, 103G00000X
FLPY9204103TC0700X, 103G00000X, 103T00000X, 103TR0400X
FL9204103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation