Provider Demographics
NPI:1952378879
Name:RIKARD, KIMBERLY HARGETT (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:HARGETT
Last Name:RIKARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 NEUSE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-4309
Mailing Address - Country:US
Mailing Address - Phone:252-633-4461
Mailing Address - Fax:252-633-6016
Practice Address - Street 1:2115 NEUSE BLVD.
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-4309
Practice Address - Country:US
Practice Address - Phone:252-633-4461
Practice Address - Fax:252-633-6016
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103252363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP47365Medicare UPIN
NC2754125AMedicare PIN