Provider Demographics
NPI:1801044664
Name:FARLEY, KIM L (PAFA)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:L
Last Name:FARLEY
Suffix:
Gender:F
Credentials:PAFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-1414
Mailing Address - Country:US
Mailing Address - Phone:207-862-5505
Mailing Address - Fax:
Practice Address - Street 1:489 STATE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6616
Practice Address - Country:US
Practice Address - Phone:207-947-6508
Practice Address - Fax:207-941-8342
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER024428163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
25765OtherANTHEM