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General NPI Number Information
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NPI Number | 1174649933
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Entity Type | Individual
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Provider Name | KIMBERLY LYNN MENDOZA PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 10/20/2022
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Provider Practice Location Address
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Address Line | 2011 HARRISON AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405-4545
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Country | US
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Telephone | 850-691-4188
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Fax | 833-687-1451
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Provider Business Mailing Address
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Address Line | 50 GOSSAMER LN UNIT 7
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City | INLET BEACH
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State | FL
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Zip | 32461-7051
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Country | US
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Telephone | 703-964-7838
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9114084
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 23539
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License Number State | FL
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