Provider Demographics
NPI:1427366905
Name:CAKERICE, KIMBERLY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:CAKERICE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:CAKERICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:4705 UNIVERSITY DR BLDG 700
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3489
Mailing Address - Country:US
Mailing Address - Phone:919-237-1337
Mailing Address - Fax:919-237-1625
Practice Address - Street 1:115 CRESCENTCOMMONS DR STE 100
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8102
Practice Address - Country:US
Practice Address - Phone:919-803-3707
Practice Address - Fax:919-803-1969
Is Sole Proprietor?:No
Enumeration Date:2010-09-19
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001001774363AM0700X
NC0010-01774363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical