Provider Demographics
NPI:1720147986
Name:MAJOR, KIMBERLY ANNE (PAC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE
Last Name:MAJOR
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2218 WILMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-7942
Mailing Address - Country:US
Mailing Address - Phone:352-840-3058
Mailing Address - Fax:910-267-1237
Practice Address - Street 1:213 9TH ST
Practice Address - Street 2:
Practice Address - City:BOLTON
Practice Address - State:NC
Practice Address - Zip Code:28423-8410
Practice Address - Country:US
Practice Address - Phone:910-655-8300
Practice Address - Fax:910-267-8997
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-05291363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical