Provider Demographics
NPI:1922431303
Name:PIERCE, KIMBERLEE ALISON (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:ALISON
Last Name:PIERCE
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 1:7550 FOLSOM AUBURN RD
Mailing Address - Street 2:APT 816
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-1769
Mailing Address - Country:US
Mailing Address - Phone:302-354-4758
Mailing Address - Fax:
Practice Address - Street 1:4156 MANZANITA AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-1496
Practice Address - Country:US
Practice Address - Phone:916-488-6337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA23061363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant