Provider Demographics
NPI:1497899561
Name:GALBREATH, KIMBERLY VANESSA (PA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:VANESSA
Last Name:GALBREATH
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 1:275 S MADERA AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:KERMAN
Mailing Address - State:CA
Mailing Address - Zip Code:93630-1401
Mailing Address - Country:US
Mailing Address - Phone:559-846-5240
Mailing Address - Fax:559-846-3787
Practice Address - Street 1:275 S MADERA AVE STE 201
Practice Address - Street 2:
Practice Address - City:KERMAN
Practice Address - State:CA
Practice Address - Zip Code:93630-1401
Practice Address - Country:US
Practice Address - Phone:559-846-5240
Practice Address - Fax:559-846-3787
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 13667363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical