Provider Demographics
NPI:1336280742
Name:PARRETT, KIMBERLY H (PA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:H
Last Name:PARRETT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-759-0700
Mailing Address - Fax:
Practice Address - Street 1:7811 N POINT BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3209
Practice Address - Country:US
Practice Address - Phone:336-759-0700
Practice Address - Fax:336-759-2226
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101357363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC454639427OtherTAX ID
VAB667OtherGROUP PTAN
NC454639427OtherTAX ID
VAB667OtherGROUP PTAN