MEDICARE: KIMBERLY HODGES

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1396006417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY HODGES

Provider Business Mailing Address
First Line	:	1475 VISTA DEL RANCHO PKWY
Second Line	:	APT212
City	:	SPARKS
State	:	NV
Zip	:	89436-6335
Country	:	US
Telephone Number	:	775-688-9360
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 HARVARD WAY
Second Line	:	105B
City	:	RENO
State	:	NV
Zip	:	89502-4002
Country	:	US
Telephone Number	:	775-420-5396
Fax Number	:

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

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	06/05/2012

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Directions to “ KIMBERLY HODGES ” Practice Location

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