Healthcare Provider Details

I. General information

NPI: 1073519278
Provider Name (Legal Business Name): JAMES HARVEY KIMBER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 VISTA VIEW TRL
SPICEWOOD TX
78669-8435
US

IV. Provider business mailing address

601 VISTA VIEW TRL
SPICEWOOD TX
78669-8435
US

V. Phone/Fax

Practice location:
  • Phone: 858-717-3181
  • Fax: 858-947-3262
Mailing address:
  • Phone: 858-717-3181
  • Fax: 858-947-3262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14852
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: