Provider Demographics
NPI:1023637899
Name:DEHIMER, KERRY ANN (PA-C)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:ANN
Last Name:DEHIMER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 EUSTIS ST APT 3R
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-2226
Mailing Address - Country:US
Mailing Address - Phone:518-429-6187
Mailing Address - Fax:
Practice Address - Street 1:2 ALFRED ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-2839
Practice Address - Country:US
Practice Address - Phone:518-429-6187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant