Provider Demographics
NPI:1851395198
Name:FARMER, KIMBERLY BROWN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:BROWN
Last Name:FARMER
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:CVS MINUTE CLINIC
Mailing Address - Street 2:6901 MARKET ST
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411
Mailing Address - Country:US
Mailing Address - Phone:866-389-2727
Mailing Address - Fax:
Practice Address - Street 1:CVS MINUTE CLINIC
Practice Address - Street 2:6901 MARKET ST
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101831363AM0700X, 363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101343Medicaid
SC1330PAMedicaid
NC1851395198Medicaid
NCNC4391BMedicare PIN
NCNC4317AMedicare PIN
NCNC4319AMedicare PIN
SC1330PAMedicaid