Provider Demographics
NPI:1457335093
Name:LOOKNER, KIMBERLY M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:M
Last Name:LOOKNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:M
Other - Last Name:JURCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:354 BIRNIE AVE.
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1109
Mailing Address - Country:US
Mailing Address - Phone:413-733-3470
Mailing Address - Fax:
Practice Address - Street 1:354 BIRNIE AVE.
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1109
Practice Address - Country:US
Practice Address - Phone:413-733-3470
Practice Address - Fax:413-733-5235
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1552363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAP1844Medicare PIN