Healthcare Provider Details

I. General information

NPI: 1083957435
Provider Name (Legal Business Name): KIMBERLY TELMANIK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY SCHERRY PA-C

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 05/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5172 LEAVITT RD
LORAIN OH
44053-2384
US

IV. Provider business mailing address

PO BOX 2066
LECANTO FL
34460-2066
US

V. Phone/Fax

Practice location:
  • Phone: 440-282-7420
  • Fax: 440-282-9855
Mailing address:
  • Phone: 352-563-0931
  • Fax: 352-563-0935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.000380
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: