Provider Demographics
NPI:1629493119
Name:STOKINGER, KIMBERLY M (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:STOKINGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:M
Other - Last Name:GRACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:26 MAIN ST STE 2
Mailing Address - Street 2:PO BOX J
Mailing Address - City:NEWPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04953-4163
Mailing Address - Country:US
Mailing Address - Phone:207-368-5747
Mailing Address - Fax:
Practice Address - Street 1:26 MAIN ST STE 2
Practice Address - Street 2:PO BOX J
Practice Address - City:NEWPORT
Practice Address - State:ME
Practice Address - Zip Code:04953-4163
Practice Address - Country:US
Practice Address - Phone:207-368-5747
Practice Address - Fax:207-368-5483
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant