Provider Demographics
NPI:1477694362
Name:MEYER, KIMBERY A (PA)
Entity Type:Individual
Prefix:
First Name:KIMBERY
Middle Name:A
Last Name:MEYER
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 1:465 BUCKLAND HILLS DR
Mailing Address - Street 2:# 32124
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-9100
Mailing Address - Country:US
Mailing Address - Phone:860-432-8679
Mailing Address - Fax:860-432-8679
Practice Address - Street 1:1 CONNECTICUT AVE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-1501
Practice Address - Country:US
Practice Address - Phone:860-859-5100
Practice Address - Fax:860-859-5110
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001812363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant