Provider Demographics
NPI:1356069785
Name:LOVEJOY, KIMBERLY ANN ROSE (PA-C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN ROSE
Last Name:LOVEJOY
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 1:2294 CHRISTY RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-6458
Mailing Address - Country:US
Mailing Address - Phone:719-432-9061
Mailing Address - Fax:
Practice Address - Street 1:410 2ND ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2115
Practice Address - Country:US
Practice Address - Phone:740-434-6030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
WV2667363A00000X
OH50.007766RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant