Provider Demographics
NPI:1225217904
Name:FARRIS, KIMBERLY J (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:FARRIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:J
Other - Last Name:BOYLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KS
Mailing Address - Zip Code:67831-0188
Mailing Address - Country:US
Mailing Address - Phone:620-635-2241
Mailing Address - Fax:
Practice Address - Street 1:625 KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KS
Practice Address - Zip Code:67831-3199
Practice Address - Country:US
Practice Address - Phone:620-635-2241
Practice Address - Fax:620-635-2229
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007032793363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO152360364Medicare PIN