| Kimberly Hines | |
|
7901 4th St N Ste 300 St Petersburg FL 33702-4399 | |
| (813) 389-7518 | |
| Not Available |
| Full Name | Kimberly Hines |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 7901 4th St N Ste 300, St Petersburg, Florida |
| Authorized Official Name and Position | Kimberly Hines (OWNER) |
| Authorized Official Contact | 8634205134 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kimberly Hines Po Box 315 Brandon FL 33509-0315 Ph: (863) 420-5134 | Kimberly Hines 7901 4th St N Ste 300 St Petersburg FL 33702-4399 Ph: (813) 389-7518 |
| NPI Number | 1366116873 |
|---|---|
| Provider Enumeration Date | 08/07/2021 |
| Last Update Date | 04/25/2023 |
| Certification Date | 04/25/2023 |
| Medicare PECOS PAC ID | 7012313653 |
|---|---|
| Medicare Enrollment ID | O20210908001384 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366116873 | NPI | - | NPPES |
| 111652900 | Medicaid | FL | |
| 1245824440 | Other | FL | CLINICAL SOCIAL WORKER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Kimberly M Hines |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245824440 PECOS PAC ID: 5294131967 Enrollment ID: I20210903000585 |
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