Provider Demographics
NPI:1649159765
Name:ROBERTS, KIMBERLY BROOKE (HIS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:BROOKE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309-2124
Mailing Address - Country:US
Mailing Address - Phone:940-867-1748
Mailing Address - Fax:
Practice Address - Street 1:1505 BEVERLY DR
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76309-2124
Practice Address - Country:US
Practice Address - Phone:940-867-1748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81162237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist