Provider Demographics
NPI:1396885562
Name:TWYMAN, KIA LAUREN (PA-C)
Entity type:Individual
Prefix:MISS
First Name:KIA
Middle Name:LAUREN
Last Name:TWYMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIA
Other - Middle Name:LAUREN
Other - Last Name:CLARKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3401 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-5103
Mailing Address - Country:US
Mailing Address - Phone:215-707-5864
Mailing Address - Fax:215-707-6860
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-5864
Practice Address - Fax:215-707-6860
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050753363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant