Provider Demographics
NPI:1609031871
Name:HANKINS, KIMBERLEA D
Entity type:Individual
Prefix:
First Name:KIMBERLEA
Middle Name:D
Last Name:HANKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5470 MOUNT MORIAH RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-4077
Mailing Address - Country:US
Mailing Address - Phone:618-926-6401
Mailing Address - Fax:
Practice Address - Street 1:5470 MOUNT MORIAH RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-4077
Practice Address - Country:US
Practice Address - Phone:618-926-6401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-27
Last Update Date:2008-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist