Provider Demographics
NPI:1922359892
Name:BASILE, KIMBERLY ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:BASILE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:KLEINBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:13840 W CAMELBACK RD STE 10
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-3084
Mailing Address - Country:US
Mailing Address - Phone:928-323-8112
Mailing Address - Fax:928-323-8113
Practice Address - Street 1:13840 W CAMELBACK RD STE 10
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-3084
Practice Address - Country:US
Practice Address - Phone:928-323-8112
Practice Address - Fax:928-323-8113
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016077363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant