Provider Demographics
NPI:1821567801
Name:MINER, KIMBERLY LEE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LEE
Last Name:MINER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:LEE
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:29 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-8602
Mailing Address - Country:US
Mailing Address - Phone:781-643-4507
Mailing Address - Fax:781-646-6151
Practice Address - Street 1:29 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-8602
Practice Address - Country:US
Practice Address - Phone:781-643-4507
Practice Address - Fax:781-646-6151
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2294610363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily