Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS017920 | PA |
N | 207QA0401X | Family Doctor - Addiction Medicine | OS017920 | PA |
NPI | 1518301522 |
---|---|
Provider Name | Kimberly Ann Kabernagel |
First Address | Danville, PA 17822-4903 |
Second Address | Waverly, PA 18471-0036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2013 |
Last Update Date | 31/08/2020 |