Provider Demographics
NPI:1285240010
Name:EDWARDS MCLEAN, KIMBERLY NICOLE (PA)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:NICOLE
Last Name:EDWARDS MCLEAN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:516 ROCKY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-4988
Mailing Address - Country:US
Mailing Address - Phone:912-381-6643
Mailing Address - Fax:
Practice Address - Street 1:516 ROCKY RIDGE DR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-4988
Practice Address - Country:US
Practice Address - Phone:912-381-6643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant