Provider Demographics
NPI:1831494335
Name:KIMMITT, HEATHER (PAC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:KIMMITT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:KERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:6410 ROCKLEDGE DR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1809
Mailing Address - Country:US
Mailing Address - Phone:301-530-4800
Mailing Address - Fax:301-530-1847
Practice Address - Street 1:6410 ROCKLEDGE DR
Practice Address - Street 2:SUITE 402
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1809
Practice Address - Country:US
Practice Address - Phone:301-530-4800
Practice Address - Fax:301-530-1847
Is Sole Proprietor?:No
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004350363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant