Provider Demographics
NPI:1679828636
Name:HRABIC, KIMBERLEE A (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:A
Last Name:HRABIC
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 1:10455 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-7046
Mailing Address - Country:US
Mailing Address - Phone:814-623-6161
Mailing Address - Fax:
Practice Address - Street 1:10455 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-7046
Practice Address - Country:US
Practice Address - Phone:814-623-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055553363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical