MEDICARE: KIMBERLY M WEIER PA-C

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	029180	NY

General Provider Information

NPI Number	:	1710609631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY M WEIER PA-C

Provider Business Mailing Address
First Line	:	17 LANSING ST
Second Line	:
City	:	AUBURN
State	:	NY
Zip	:	13021-1983
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	77 NELSON ST STE 240
Second Line	:
City	:	AUBURN
State	:	NY
Zip	:	13021-1944
Country	:	US
Telephone Number	:	315-567-0390
Fax Number	:

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

Provider Enumeration Date	:	09/16/2022
Last Update Date	:	03/10/2026

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