Provider Demographics
NPI:1255345336
Name:HENDRICKS, KIMBERLY S (DO)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:S
Other - Last Name:ENGLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:7707 PARAGON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4041
Mailing Address - Country:US
Mailing Address - Phone:937-208-6920
Mailing Address - Fax:937-208-6920
Practice Address - Street 1:800 WAYNE ST STE 100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-3309
Practice Address - Country:US
Practice Address - Phone:740-568-2214
Practice Address - Fax:740-568-2099
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03199207RR0500X
OH34.008678207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH310917085249OtherOH MEDICAID CARESOURCE
OH2678348Medicaid
OH000000414491OtherOH MEDICAID UNISON
OHP00962152OtherRAILROAD MEDICARE
OH2678348OtherOHIO MEDICAID MOLINA
OH000000414491OtherOH MEDICAID UNISON
OH2678348OtherOHIO MEDICAID MOLINA