Provider Demographics
NPI:1437134277
Name:FARRELL, KIMBERLY A (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:A
Last Name:FARRELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1604 BURTNER RD
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-2845
Mailing Address - Country:US
Mailing Address - Phone:724-230-3073
Mailing Address - Fax:724-230-3145
Practice Address - Street 1:3471 5TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3209
Practice Address - Country:US
Practice Address - Phone:412-648-6979
Practice Address - Fax:412-692-4410
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003029L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP11036Medicare UPIN