Provider Demographics
NPI:1801784111
Name:KILMER, ABIGAIL ROSE (PA-C)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:ROSE
Last Name:KILMER
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 1:15240 N 142ND AVE UNIT 1127
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-8762
Mailing Address - Country:US
Mailing Address - Phone:616-745-8702
Mailing Address - Fax:
Practice Address - Street 1:4530 E RAY RD STE 125
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6096
Practice Address - Country:US
Practice Address - Phone:602-343-6167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11139207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty