MEDICARE: KIMBERLY A PETRILA P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1528223658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY A PETRILA P.A.

Provider Business Mailing Address
First Line	:	5920 SARATOGA BLVD STE 600A
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-4119
Country	:	US
Telephone Number	:	361-994-1166
Fax Number	:	361-994-7046

Provider Business Practice Location Address
First Line	:	5920 SARATOGA BLVD STE 600A
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-4119
Country	:	US
Telephone Number	:	361-994-1166
Fax Number	:	361-994-7046

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2008
Last Update Date	:	11/09/2017

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Directions to “ KIMBERLY A PETRILA P.A.” Practice Location

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