Provider Demographics
NPI:1326382813
Name:SORRELL, KIMBERLEY ANN (ANP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:ANN
Last Name:SORRELL
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 DURAND RD
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-7902
Mailing Address - Country:US
Mailing Address - Phone:518-562-8304
Mailing Address - Fax:
Practice Address - Street 1:128 RAY BROOK ROAD
Practice Address - Street 2:
Practice Address - City:RAY BROOK
Practice Address - State:NY
Practice Address - Zip Code:12977-0300
Practice Address - Country:US
Practice Address - Phone:518-897-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306202363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health