Provider Demographics
NPI:1033149398
Name:CARDEN, KIMMIE A (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:KIMMIE
Middle Name:A
Last Name:CARDEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:307 E 3RD AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-3208
Mailing Address - Country:US
Mailing Address - Phone:229-271-4656
Mailing Address - Fax:
Practice Address - Street 1:135 DOGWOOD ST SW
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015
Practice Address - Country:US
Practice Address - Phone:229-535-4567
Practice Address - Fax:229-535-6556
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004289363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ24832Medicare UPIN