Provider Demographics
NPI:1225578909
Name:HARTER, KIMBERLY A (PA-C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:HARTER
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1034 ROANOKE DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8088
Mailing Address - Country:US
Mailing Address - Phone:765-461-7244
Mailing Address - Fax:
Practice Address - Street 1:581 S RANGELINE RD STE B2
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2149
Practice Address - Country:US
Practice Address - Phone:317-669-9774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017002000363A00000X
IN10002539A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant