MEDICARE: KIMBERLY SHIRK PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	2504	SC

General Provider Information

NPI Number	:	1164683926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY SHIRK PA-C

Provider Business Mailing Address
First Line	:	612 SAINT ANDREWS RD STE 2
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-3947
Country	:	US
Telephone Number	:	803-386-8684
Fax Number	:

Provider Business Practice Location Address
First Line	:	612 SAINT ANDREWS RD STE 2
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-5120
Country	:	US
Telephone Number	:	803-386-8684
Fax Number	:	844-436-4944

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2008
Last Update Date	:	03/17/2018

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Directions to “ KIMBERLY SHIRK PA-C” Practice Location

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