Provider Demographics
NPI:1134166234
Name:CHUTE, KIMBERLEE I (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLEE
Middle Name:I
Last Name:CHUTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KIMBERLEE
Other - Middle Name:I
Other - Last Name:MILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:333 BORTHWICK AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7128
Mailing Address - Country:US
Mailing Address - Phone:603-559-4111
Mailing Address - Fax:603-559-4110
Practice Address - Street 1:333 BORTHWICK AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7128
Practice Address - Country:US
Practice Address - Phone:603-559-4111
Practice Address - Fax:603-559-4110
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0574363AS0400X
MEPA001043363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432081799Medicaid
NH30334043Medicaid
ME432081799Medicaid
NHAP2553Medicare PIN
NHP75983Medicare UPIN
MEAP2553Medicare PIN