Provider Demographics
NPI:1669592457
Name:LEWIS, KIMBERLY A (PA -C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PA -C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 986513
Mailing Address - Street 2:DEPARTMENT 100
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02298-6513
Mailing Address - Country:US
Mailing Address - Phone:910-219-8326
Mailing Address - Fax:910-939-4269
Practice Address - Street 1:118 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6328
Practice Address - Country:US
Practice Address - Phone:910-353-0581
Practice Address - Fax:910-577-1150
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2023-11-03
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Provider Licenses
StateLicense IDTaxonomies
NC103307363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1669592457Medicaid