Provider Demographics
NPI:1518912658
Name:FARRIS, KIM (PA-C)
Entity Type:Individual
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First Name:KIM
Middle Name:
Last Name:FARRIS
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2611 ELECTRIC AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6587
Mailing Address - Country:US
Mailing Address - Phone:810-987-9871
Mailing Address - Fax:810-987-6070
Practice Address - Street 1:2611 ELECTRIC AVE
Practice Address - Street 2:SUITE E
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6587
Practice Address - Country:US
Practice Address - Phone:810-987-9871
Practice Address - Fax:810-987-6070
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2010-06-25
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Provider Licenses
StateLicense IDTaxonomies
IA001662363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant