Provider Demographics
NPI:1689627457
Name:CEASER, KIMBERLY L (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:CEASER
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 1:1134 N ROAD ST
Mailing Address - Street 2:BLDG. 9
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3365
Mailing Address - Country:US
Mailing Address - Phone:252-338-9451
Mailing Address - Fax:252-338-9170
Practice Address - Street 1:4810 S CROATAN HWY
Practice Address - Street 2:SUITE 110
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-8508
Practice Address - Country:US
Practice Address - Phone:252-441-2444
Practice Address - Fax:252-441-8910
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1066914363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q53980Medicare UPIN
2764346Medicare ID - Type Unspecified