Provider Demographics
NPI:1073519278
Name:KIMBER, JAMES HARVEY (PA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:HARVEY
Last Name:KIMBER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 VISTA VIEW TRL
Mailing Address - Street 2:
Mailing Address - City:SPICEWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78669-8435
Mailing Address - Country:US
Mailing Address - Phone:858-717-3181
Mailing Address - Fax:858-947-3262
Practice Address - Street 1:601 VISTA VIEW TRL
Practice Address - Street 2:
Practice Address - City:SPICEWOOD
Practice Address - State:TX
Practice Address - Zip Code:78669-8435
Practice Address - Country:US
Practice Address - Phone:858-717-3181
Practice Address - Fax:858-947-3262
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14852363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB231407Medicare UPIN
CAWPA17397AMedicare ID - Type Unspecified