Provider Demographics
NPI:1265511489
Name:ETHERINGTON, KIMBERLY ELIZABETH (PA)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ELIZABETH
Last Name:ETHERINGTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1519 S PHILLIPS ST
Mailing Address - Street 2:
Mailing Address - City:ALGONA
Mailing Address - State:IA
Mailing Address - Zip Code:50511-3649
Mailing Address - Country:US
Mailing Address - Phone:515-295-2451
Mailing Address - Fax:515-295-4505
Practice Address - Street 1:1519 S PHILLIPS ST
Practice Address - Street 2:
Practice Address - City:ALGONA
Practice Address - State:IA
Practice Address - Zip Code:50511-3649
Practice Address - Country:US
Practice Address - Phone:515-295-2451
Practice Address - Fax:515-295-4505
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA001109363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA36657OtherWELLMARK
IA45658OtherWELLMARK
IA36657OtherWELLMARK