Provider Demographics
NPI:1013930114
Name:ESTES, KIMBERLEY H (PA)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:H
Last Name:ESTES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 OAK ST STE 200W
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1191
Mailing Address - Country:US
Mailing Address - Phone:774-480-1600
Mailing Address - Fax:774-480-1603
Practice Address - Street 1:830 OAK ST STE 200W
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1191
Practice Address - Country:US
Practice Address - Phone:774-480-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00373363A00000X
MAPA664363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant