Provider Demographics
NPI:1538248018
Name:HANKS, KIMBERLY LOUISE (PA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LOUISE
Last Name:HANKS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:LOUISE
Other - Last Name:HANKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:500 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-9702
Mailing Address - Country:US
Mailing Address - Phone:707-382-2921
Mailing Address - Fax:
Practice Address - Street 1:500 5TH ST
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9702
Practice Address - Country:US
Practice Address - Phone:541-412-3000
Practice Address - Fax:541-412-2081
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15015363A00000X
ORPA165753363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1083656367OtherCURRY MEDICAL CENTER'S NPI
OR1487696985OtherCURRY GENERAL HOSPITAL'S NPI
OR500605015Medicaid