Provider Demographics
NPI:1366503401
Name:ATKINSON, KIMBERLY A (DO)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:A
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:909 WALNUT STREET
Mailing Address - Street 2:COB 2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5509
Mailing Address - Country:US
Mailing Address - Phone:215-955-1234
Mailing Address - Fax:215-923-6792
Practice Address - Street 1:909 WALNUT STREET
Practice Address - Street 2:COB 2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5509
Practice Address - Country:US
Practice Address - Phone:215-955-1234
Practice Address - Fax:215-923-6792
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007552L2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01160833802Medicaid
PAG25129Medicare UPIN
PA01160833802Medicaid