Provider Demographics
NPI:1871584334
Name:HART, KIMBERLY A (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:HART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 PASADENA DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2925
Mailing Address - Country:US
Mailing Address - Phone:859-278-1316
Mailing Address - Fax:859-685-0340
Practice Address - Street 1:2416 REGENCY ROAD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2925
Practice Address - Country:US
Practice Address - Phone:859-278-1316
Practice Address - Fax:859-685-0340
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA913363A00000X
KYTC649363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000586592OtherANTHEM
KY0688831Medicare PIN