Provider Demographics
NPI:1063494995
Name:ADAMSON, KIMBERLY J (CPNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:ADAMSON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 BOYDEN RD
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-2570
Mailing Address - Country:US
Mailing Address - Phone:508-885-2003
Mailing Address - Fax:508-885-8071
Practice Address - Street 1:64 BOYDEN RD
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-2570
Practice Address - Country:US
Practice Address - Phone:508-885-2003
Practice Address - Fax:508-885-8071
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235904363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110085950AMedicaid