Provider Demographics
NPI:1700061645
Name:CRAY, KIMBERLY ROSE (PA)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ROSE
Last Name:CRAY
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Gender:F
Credentials:PA
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Mailing Address - Street 1:15051 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-5182
Mailing Address - Country:US
Mailing Address - Phone:239-437-8810
Mailing Address - Fax:239-313-2555
Practice Address - Street 1:3659 S MIAMI AVE
Practice Address - Street 2:SUITE 6008
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4227
Practice Address - Country:US
Practice Address - Phone:305-856-6555
Practice Address - Fax:305-856-6556
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2017-05-03
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Provider Licenses
StateLicense IDTaxonomies
FL9104464363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant