Provider Demographics
NPI:1770037210
Name:DUCKETT, KIMBERLY E (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:E
Last Name:DUCKETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:E
Other - Last Name:ACTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1306 CONCOURSE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM
Mailing Address - State:MD
Mailing Address - Zip Code:21090-1033
Mailing Address - Country:US
Mailing Address - Phone:410-384-9311
Mailing Address - Fax:
Practice Address - Street 1:231 NAJOLES RD STE 300
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-2659
Practice Address - Country:US
Practice Address - Phone:443-351-3376
Practice Address - Fax:443-494-2303
Is Sole Proprietor?:No
Enumeration Date:2016-08-13
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical