MEDICARE: MS. KIMBERLEY CLOTHIER PA

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	363A00000X	Physician Assistant	042538	KS

General Provider Information

NPI Number	:	1356349443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLEY CLOTHIER PA

Provider Business Mailing Address
First Line	:	3715 N OLIVER ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67220-3404
Country	:	US
Telephone Number	:	316-942-4519
Fax Number	:	316-262-4887

Provider Business Practice Location Address
First Line	:	3715 N OLIVER ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67220
Country	:	US
Telephone Number	:	316-942-4519
Fax Number	:	316-942-4655

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	10/05/2020

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