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NPI Code Detail

MEDICARE: KIMBERLY MALLICK FILLMAN P.A.

MEDICARE: KIMBERLY MALLICK FILLMAN P.A.
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 Assistant101827NC
2363AM0700XMedical Physician Assistant101827NC

General Provider Information

NPI Number : 1578563235
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY MALLICK FILLMAN P.A.
Provider Business Mailing Address
First Line : 240 HOSPITAL DR NE
Second Line :
City : BOLIVIA
State : NC
Zip : 28422-8346
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 240 HOSPITAL DR NE
Second Line :
City : BOLIVIA
State : NC
Zip : 28422-8346
Country : US
Telephone Number : 843-497-5929
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2005
Last Update Date : 07/15/2020

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