Provider Demographics
NPI:1326473596
Name:SERINE, KIMBERLY THI (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:THI
Last Name:SERINE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 S RIVER ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18705-1033
Mailing Address - Country:US
Mailing Address - Phone:570-552-7170
Mailing Address - Fax:570-552-7169
Practice Address - Street 1:672 S RIVER ST STE 101
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-1033
Practice Address - Country:US
Practice Address - Phone:570-552-7170
Practice Address - Fax:570-552-7169
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2021-08-09
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant