Provider Demographics
NPI:1285773911
Name:KIMBER, STACEY CAROL (PA-C)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:CAROL
Last Name:KIMBER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:CAROL
Other - Last Name:HATCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8323 MELODY LN
Mailing Address - Street 2:
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-1711
Mailing Address - Country:US
Mailing Address - Phone:216-308-2785
Mailing Address - Fax:
Practice Address - Street 1:8940 DARROW RD
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2110
Practice Address - Country:US
Practice Address - Phone:330-425-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant