Provider Demographics
NPI:1871590562
Name:COMPTON, KIMBERLY DILLON (PA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DILLON
Last Name:COMPTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1019
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:VA
Mailing Address - Zip Code:24171-1019
Mailing Address - Country:US
Mailing Address - Phone:276-694-4466
Mailing Address - Fax:276-694-2909
Practice Address - Street 1:18877 JEB STUART HIGHWAY
Practice Address - Street 2:HIGHWAY 58
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171-1019
Practice Address - Country:US
Practice Address - Phone:276-694-4466
Practice Address - Fax:276-694-2909
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110 001045363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
970000466Medicare ID - Type Unspecified
VAP29022Medicare UPIN