Provider Demographics
NPI:1750772018
Name:KIMES, KATE (DO)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:KIMES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:BALDRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1060 GAFFNEY RD
Mailing Address - Street 2:
Mailing Address - City:FT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-5002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1060 GAFFNEY RD
Practice Address - Street 2:
Practice Address - City:FT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703-5002
Practice Address - Country:US
Practice Address - Phone:907-361-5644
Practice Address - Fax:907-361-4823
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1513207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology