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NPI Code Detail

MEDICARE: KIMBERLY HETSKO M.ED.

MEDICARE: KIMBERLY HETSKO M.ED.
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
1103K00000XBehavior Analyst0133002071VA
2103K00000XBehavior AnalystBH003711PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11-19-34950OTHERBACB

General Provider Information

NPI Number : 1427518463
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY HETSKO M.ED.
Provider Business Mailing Address
First Line : 780 LYNNHAVEN PKWY STE 400
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23452-7332
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 780 LYNNHAVEN PKWY STE 400
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23452-7332
Country : US
Telephone Number : 757-266-7643
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2019
Last Update Date : 06/26/2026

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Directions to “ KIMBERLY HETSKO M.ED.” Practice Location

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