MEDICARE: KATE KIMES D.O.

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	207N00000X	Dermatology Physician	1513	NE

General Provider Information

NPI Number	:	1750772018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATE KIMES D.O.

Provider Business Mailing Address
First Line	:	1060 GAFFNEY RD
Second Line	:
City	:	FT WAINWRIGHT
State	:	AK
Zip	:	99703-5002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1060 GAFFNEY RD
Second Line	:
City	:	FT WAINWRIGHT
State	:	AK
Zip	:	99703-5002
Country	:	US
Telephone Number	:	907-361-5644
Fax Number	:	907-361-4823

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

Provider Enumeration Date	:	02/09/2015
Last Update Date	:	12/28/2021

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Directions to “ KATE KIMES D.O.” Practice Location

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