MEDICARE: KIMBERLY BLACK HIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist		AL

General Provider Information

NPI Number	:	1043613318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY BLACK HIS

Provider Business Mailing Address
First Line	:	662 HARBOR BLVD
Second Line	:	STE 140
City	:	DESTIN
State	:	FL
Zip	:	32541-2473
Country	:	US
Telephone Number	:	850-243-3196
Fax Number	:	850-270-5124

Provider Business Practice Location Address
First Line	:	4318 DOWNTOWNER LOOP N STE K
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36609-5508
Country	:	US
Telephone Number	:	251-343-3633
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2014
Last Update Date	:	01/20/2026

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Directions to “ KIMBERLY BLACK HIS” Practice Location

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