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General NPI Number Information
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NPI Number | 1902909872
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Entity Type | Individual
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Provider Name | KIMBERLY ANN MATZEL PAC
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Gender | Female
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 01/23/2014
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Provider Practice Location Address
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Address Line | 2111 COLLEGE AVE BLUEFIELD INTERNAL MEDICINE
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City | BLUEFIELD
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State | VA
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Zip | 24605
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Country | US
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Telephone | 276-322-4661
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Fax | 276-322-4663
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Provider Business Mailing Address
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Address Line | 2111 COLLEGE AVE
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City | BLUEFIELD
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State | VA
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Zip | 24605
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Country | US
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Telephone | 276-322-4661
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Fax | 276-322-4663
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0110840635
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 590
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License Number State | WV
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