Provider Demographics
NPI:1285643601
Name:BROSAMER, KIMBERLY MARIE (PA)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:MARIE
Last Name:BROSAMER
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Gender:F
Credentials:PA
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Mailing Address - Street 1:7810 PROVIDENCE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-2954
Mailing Address - Country:US
Mailing Address - Phone:704-543-6636
Mailing Address - Fax:704-752-4185
Practice Address - Street 1:7810 PROVIDENCE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-2954
Practice Address - Country:US
Practice Address - Phone:704-543-6636
Practice Address - Fax:704-752-4185
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2011-03-18
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Provider Licenses
StateLicense IDTaxonomies
NC103966363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical