Provider Demographics
NPI:1780967943
Name:KERKSIEK, KIMBERLY ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:KERKSIEK
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 1:3817 28TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-2505
Mailing Address - Country:US
Mailing Address - Phone:806-470-4506
Mailing Address - Fax:
Practice Address - Street 1:7606 UNIVERSITY AVE
Practice Address - Street 2:SUITE B-3
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2155
Practice Address - Country:US
Practice Address - Phone:806-470-4506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201069106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist