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Contact Information

KIMBERLY N HACKNEY, DO
300 WINDING WOODS DR STE 120
O'FALLON, MO63366-4772
 Phone: 636-978-7902
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

208000000X 37 Physician/Pediatric Medicine
 

Pediatric Emergency Medicine

2080P0204X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for KIMBERLY N HACKNEY · (Female)

NPI Number 1083842454
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 06/24/2009
Last updated 11/28/2017 - About 9 years ago
Sole proprietor 1 No
Identifiers
  • KS License # 05-35901
  • MO License # 2010037113
  • MO Medicaid 1083842454
  • IL Other PAYEE 1 ILLINOIS MEDICAL ASSISTANCE PROGRAM
  • MO Other P01296531 RAILROAD MEDICARE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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