Provider Demographics
NPI:1720213549
Name:BACHMAN, KIMBERLY JOHNSEN (PA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JOHNSEN
Last Name:BACHMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11020 RCA CENTER DRIVE
Mailing Address - Street 2:SUITE 2010
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410
Mailing Address - Country:US
Mailing Address - Phone:561-881-8800
Mailing Address - Fax:
Practice Address - Street 1:11020 RCA CENTER DR
Practice Address - Street 2:SUITE 2010
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4277
Practice Address - Country:US
Practice Address - Phone:561-881-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 3013363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant