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NPI Code Detail

MEDICARE: MRS. KIMBERLY ANN MOON PA-C

MEDICARE: MRS. KIMBERLY ANN MOON 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
1363A00000XPhysician Assistant5998SC

General Provider Information

NPI Number : 1194892273
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMBERLY ANN MOON PA-C
Provider Business Mailing Address
First Line : 405 LANCASTER AVE
Second Line :
City : GREER
State : SC
Zip : 29650-1235
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 405 LANCASTER AVE
Second Line :
City : GREER
State : SC
Zip : 29650-1235
Country : US
Telephone Number : 864-663-0896
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2006
Last Update Date : 12/29/2025

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Directions to “ MRS. KIMBERLY ANN MOON PA-C” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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