Provider Demographics
NPI:1225702871
Name:MESSINA, KIMBERLY SUMNER (PA-C)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:SUMNER
Last Name:MESSINA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:SUMNER
Other - Last Name:THORNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:118 GATEWAY BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6542
Mailing Address - Country:US
Mailing Address - Phone:704-230-1302
Mailing Address - Fax:704-230-1284
Practice Address - Street 1:118 GATEWAY BLVD STE A
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6542
Practice Address - Country:US
Practice Address - Phone:704-230-1302
Practice Address - Fax:704-230-1284
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-06
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-11936363AM0700X
NC363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty