Healthcare Provider Details

I. General information

NPI: 1013392869
Provider Name (Legal Business Name): KIMBERLY S HUTCHINSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 OAKFIELD DR STE 252
BRANDON FL
33511-4924
US

IV. Provider business mailing address

PO BOX 100166
CAPE CORAL FL
33910-0166
US

V. Phone/Fax

Practice location:
  • Phone: 239-295-6564
  • Fax: 888-801-3850
Mailing address:
  • Phone: 239-295-6564
  • Fax: 888-801-3850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1330
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY9204
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY9204
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY9204
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number9204
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1330
License Number StateLA
# 7
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number1330
License Number StateLA
# 8
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPY9204
License Number StateFL
# 9
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1330
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: