Provider Demographics
NPI:1144324336
Name:DURAN, KIMBERLY RAE (PAC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RAE
Last Name:DURAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 SCRIPPS DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6372
Mailing Address - Country:US
Mailing Address - Phone:916-779-1160
Mailing Address - Fax:916-779-1166
Practice Address - Street 1:87 SCRIPPS DR
Practice Address - Street 2:SUITE 310
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6372
Practice Address - Country:US
Practice Address - Phone:916-779-1160
Practice Address - Fax:916-779-1166
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15500207VX0201X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA155000Medicare UPIN