Provider Demographics
NPI:1053895300
Name:HAGELSTEIN, KIMBERLY (MAT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:HAGELSTEIN
Suffix:
Gender:F
Credentials:MAT, LAT, ATC
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 1036
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:TX
Mailing Address - Zip Code:79782-1036
Mailing Address - Country:US
Mailing Address - Phone:806-216-0586
Mailing Address - Fax:
Practice Address - Street 1:1412 MOCKINGBIRD LN APT J202
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-2065
Practice Address - Country:US
Practice Address - Phone:806-216-0586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-22
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT82692255A2300X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer