Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 0101236745 | VA |
N | 208600000X | Surgeon | 0101236745 | VA |
Y | 208200000X | Surgeon | 35-098120 | OH |
Y | 208600000X | Surgeon | 35-098120 | OH |
N | 2086S0102X | Surgical Critical Care | 42751 | TN |
N | 2086S0127X | Trauma Surgeon | 42751 | TN |
NPI | 1134157928 |
---|---|
Provider Name | Kimberly M Hendershot |
First Address | Dayton, OH 45401-1144 |
Second Address | Dayton, OH 45409-2939 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 27/10/2011 |