Provider Demographics
NPI:1881744498
Name:LOVATO, KIMBERLY K (PA)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:K
Last Name:LOVATO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:190 SE 8TH AVE # A-201
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4216
Mailing Address - Country:US
Mailing Address - Phone:503-352-7333
Mailing Address - Fax:971-266-2956
Practice Address - Street 1:705 SE BASELINE ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4244
Practice Address - Country:US
Practice Address - Phone:503-352-7333
Practice Address - Fax:971-266-2956
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA01186363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical