Provider Demographics
NPI:1073620076
Name:FERENCE, KIMBERLY LYNN (PAC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LYNN
Last Name:FERENCE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:MCCRITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:135 TIDEWATER DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570
Mailing Address - Country:US
Mailing Address - Phone:910-381-4834
Mailing Address - Fax:
Practice Address - Street 1:114C MEMORIAL DR
Practice Address - Street 2:FAMILY CARE CLINIC P.A.
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6328
Practice Address - Country:US
Practice Address - Phone:910-353-9688
Practice Address - Fax:910-353-7498
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103754363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant