Provider Demographics
NPI:1336280742
Name:PARRETT, KIMBERLY H (PA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:H
Last Name:PARRETT
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 VALLEYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-3137
Mailing Address - Country:US
Mailing Address - Phone:336-408-0810
Mailing Address - Fax:
Practice Address - Street 1:631 CC CAMP RD
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-8705
Practice Address - Country:US
Practice Address - Phone:336-366-1072
Practice Address - Fax:336-527-7083
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101357363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB667OtherGROUP PTAN
NC454639427OtherTAX ID
NC454639427OtherTAX ID
VAB667OtherGROUP PTAN