Provider Demographics
NPI:1780974550
Name:HANKS, KIM M (ACNP)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:M
Last Name:HANKS
Suffix:
Gender:F
Credentials:ACNP
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Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:MC 7977
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-450-9000
Mailing Address - Fax:210-450-4903
Practice Address - Street 1:4502 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4402
Practice Address - Country:US
Practice Address - Phone:210-358-8001
Practice Address - Fax:210-358-4429
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2011-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX679761363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282197701Medicaid
TX282197701Medicaid