Provider Demographics
NPI:1639349244
Name:KIMMEL, KAREN MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MARIE
Last Name:KIMMEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-4607
Mailing Address - Country:US
Mailing Address - Phone:304-822-4932
Mailing Address - Fax:304-822-4963
Practice Address - Street 1:329 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-4607
Practice Address - Country:US
Practice Address - Phone:304-822-4932
Practice Address - Fax:304-822-4963
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01337363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant