Basic Information
| Provider Information | |||||||||
| NPI: | 1992461677 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HINKSON | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | JO | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | THERAPIST | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 8101 KUYKENDAHL RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773821563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8557827822 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8101 KUYKENDAHL RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773821563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8557827822 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2021 | ||||||||
| LastUpdateDate: | 11/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 11/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | TX | Y |
ID Information
| ID | Type | State | Issuer | Description | 0 | 01 | TX | N/A | OTHER |