Provider Demographics
NPI:1033736780
Name:HARRIS, KIMBERLY LAUREN (PA-C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LAUREN
Last Name:HARRIS
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 1:114 APPLE BLOSSOM WAY
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1165
Mailing Address - Country:US
Mailing Address - Phone:240-620-7810
Mailing Address - Fax:
Practice Address - Street 1:6565 N CHARLES ST STE 601
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-5801
Practice Address - Country:US
Practice Address - Phone:410-821-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0007510363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant