Provider Demographics
NPI:1255491338
Name:TALBOT, KIM (PA)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:TALBOT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:WARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:284 MONPONSETT ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HALIFAX
Mailing Address - State:MA
Mailing Address - Zip Code:02338-1430
Mailing Address - Country:US
Mailing Address - Phone:781-293-7210
Mailing Address - Fax:
Practice Address - Street 1:284 MONPONSETT ST
Practice Address - Street 2:SUITE 206
Practice Address - City:HALIFAX
Practice Address - State:MA
Practice Address - Zip Code:02338-1430
Practice Address - Country:US
Practice Address - Phone:781-293-7210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1453363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP77856Medicare UPIN
MAAP1873Medicare PIN