Provider Demographics
NPI:1619911740
Name:CASE, KIMBERLY ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE
Last Name:CASE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1760 NICHOLASVILLE RD STE 402
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1444
Mailing Address - Country:US
Mailing Address - Phone:859-278-0383
Mailing Address - Fax:859-278-0316
Practice Address - Street 1:1760 NICHOLASVILLE RD STE 402
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1444
Practice Address - Country:US
Practice Address - Phone:859-278-0383
Practice Address - Fax:859-278-0316
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA882363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9500620100Medicaid
KY9500620100Medicaid
KY0973304Medicare PIN