Healthcare Provider Details

I. General information

NPI: 1013930114
Provider Name (Legal Business Name): KIMBERLEY H. ESTES P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MILL RD STE 120
FAIRHAVEN MA
02719-5252
US

IV. Provider business mailing address

200 MILL RD STE 180
FAIRHAVEN MA
02719-5255
US

V. Phone/Fax

Practice location:
  • Phone: 508-973-3200
  • Fax: 508-973-3215
Mailing address:
  • Phone: 508-973-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number00373
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA664
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: