Provider Demographics
NPI:1548514292
Name:ABELLA-CREE, KIMBERLY RAE (PA-C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RAE
Last Name:ABELLA-CREE
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 1:111 S 11TH AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3242
Mailing Address - Country:US
Mailing Address - Phone:509-574-4433
Mailing Address - Fax:509-574-4432
Practice Address - Street 1:111 S 11TH AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3242
Practice Address - Country:US
Practice Address - Phone:509-574-4433
Practice Address - Fax:509-574-4432
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60317100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant