Healthcare Provider Details

I. General information

NPI: 1235443318
Provider Name (Legal Business Name): MARIA KIMMEL MARQUETTE PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA KIMMEL CAPETS

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N 4TH ST
YOUNGWOOD PA
15697-1559
US

IV. Provider business mailing address

505 N 4TH ST
YOUNGWOOD PA
15697-1559
US

V. Phone/Fax

Practice location:
  • Phone: 724-925-1211
  • Fax: 724-925-2931
Mailing address:
  • Phone: 724-925-1211
  • Fax: 724-925-2931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA055237
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: