Provider Demographics
NPI:1174639769
Name:WEEKES, KIMBERLY H (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:H
Last Name:WEEKES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5408 W BURLEIGH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1624
Mailing Address - Country:US
Mailing Address - Phone:414-445-6520
Mailing Address - Fax:414-445-6875
Practice Address - Street 1:5408 W BURLEIGH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1624
Practice Address - Country:US
Practice Address - Phone:414-445-6520
Practice Address - Fax:414-445-6875
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1756-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41996800Medicaid
WI41996800Medicaid
WI73840-0250Medicare ID - Type Unspecified