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General NPI Number Information
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NPI Number | 1679626840
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Entity Type | Individual
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Provider Name | KIMBERLY S HUMPHRIES PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 11/18/2013
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Provider Practice Location Address
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Address Line | 141 N EAGLE CREEK DR STE 200
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City | LEXINGTON
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State | KY
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Zip | 40509-2538
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Country | US
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Telephone | 859-543-1000
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Fax | 859-543-0399
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Provider Business Mailing Address
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Address Line | 141 N. EAGLE CREEK DRIVE, SUITE 200
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City | LEXINGTON
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State | KY
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Zip | 40509
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Country | US
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Telephone | 859-266-2273
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Fax | 859-266-2274
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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 | PA736
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA736
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License Number State | KY
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