KIMBERLEE MACK (NPI# 1396284592) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396284592 |
| Entity Type | Individual |
| Full Name | KIMBERLEE MACK |
| Credential | PA-C |
| Practice Address |
400 Shadow Mountain Dr El Paso TX 79912-4030 |
| Mailing Address |
1335 Geronimo Dr El Paso TX 79925-1836 |
| Practice Telephone | 9155912704 |
| Practice Fax Number | 9152250413 |
| Mailing Telephone | 9155912704 |
| Mailing Fax Number | 9152250413 |
| Enumeration Date | 2017-02-21 |
| Last Update Date | 2017-10-17 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA11188 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
400 SHADOW MOUNTAIN DR |
| City | EL PASO |
| State | TX |
| Zip Code | 79912-4030 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558725895 | Elizabeth Osaade | Nurse Practitioner | 400 Shadow Mountain Dr, El Paso, TX 79912-4030 | 2016-04-13 |
| 1982260048 | Kate Eunhyang Jin | Nurse Practitioner | 400 Shadow Mountain Dr, El Paso, TX 79912-4030 | 2019-05-14 |
| 1164087904 | Myra Ivette Robles | Nurse Practitioner | 400 Shadow Mountain Dr, El Paso, TX 79912-4030 | 2019-05-07 |
| 1740772235 | Sydney Elizabeth Owens Rasmussen | Physician Assistant | 400 Shadow Mountain Dr, El Paso, TX 79912-4030 | 2018-05-31 |
| 1730688151 | Oluwademilade O Evbuomwan | Nurse Practitioner | 400 Shadow Mountain Dr, El Paso, TX 79912-4030 | 2018-02-12 |
| 1831601491 | Hannah Grace Moffitt | Nurse Practitioner | 400 Shadow Mountain Dr, El Paso, TX 79912-4030 | 2017-11-03 |
| 1447773338 | Cresilda Juarez Yuson | Nurse Practitioner | 400 Shadow Mountain Dr, El Paso, TX 79912-4030 | 2017-07-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851903801 | Cristina Valerie Quinones | Registered Nurse | 444 Executive Blvd., Suite 148, El Paso, TX 79912 | 2020-08-20 |
| 1528698255 | Thomas Wayne Woo Sr. | Physical Therapist | 7430 Remcon Circle Bldg A, El Paso, TX 79912 | 2020-01-22 |
| 1760030290 | Susan De La Cruz | Nurse Practitioner | 6600 N Dessert Blvd, El Paso, TX 79912 | 2019-08-28 |
| 1558925438 | Smiles 4 Less Orthodontics, P.a. | Dentist | 7480 Remcon Cir, El Paso, TX 79912 | 2019-04-26 |
| 1831669423 | Jorge Lorenzo Soto | Occupational Therapy Assistant | 4700 N. Mesa St. F-4, El Paso, TX 79912 | 2018-11-27 |
| 1811464126 | Paloma Herrera | Spec/Tech, Health Info | 200 N Festival, El Paso, TX 79912 | 2018-10-25 |
| 1265910178 | Texas Kids Dental Care West Pa | Clinic/Center | 7480 Remcon, El Paso, TX 79912 | 2018-08-02 |
| 1528555463 | Wal-mart Stores Texas, LLC | Durable Medical Equipment & Medical Supplies | 7831 Paseo Del Norte Blvd, Ste A, El Paso, TX 79912 | 2018-04-17 |
| 1679078927 | Kassandra Ashley Wright | Registered Nurse | 330 Bartlett Dr. Apt 2002, El Paso, TX 79912 | 2018-03-28 |
| 1013410802 | Maranatha Physical Medicine & Rehabilitation, Pllc | Physical Medicine & Rehabilitation | 7100 Westwind Dr Ste 155, El Paso, TX 79912 | 2018-03-17 |
| Find all providers in zip 79912 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598371791 | Miriam Leticia Munoz | Physician Assistant | 646 Mike Carbajal Rd, El Paso, TX 79927-2149 | 2020-09-22 |
| 1184264541 | Rodrigo Carrasco | Physician Assistant | 7560 Wolf Creek Dr, El Paso, TX 79911-3143 | 2020-01-13 |
| 1134764558 | Andrea Pilar Stam | Physician Assistant | 5005 N. Piedras Street; Attn, Wbamc, El Paso, TX 79920-5001 | 2019-11-08 |
| 1326680786 | Lori Evelyn Berumen | Physician Assistant | 7100 Westwind Dr Ste 120, El Paso, TX 79912-1757 | 2019-10-17 |
| 1609437946 | Ruben Andy Medina | Physician Assistant | 179 Vinson Way, El Paso, TX 79915-4227 | 2019-06-26 |
| 1790344331 | Alexandra Apodaca | Physician Assistant | 1641 Bessemer Dr, El Paso, TX 79936-5226 | 2019-06-07 |
| 1427518901 | Danielle Hicks | Physician Assistant | 2496 Ricker Rd., El Paso, TX 79916 | 2019-03-21 |
| 1023586211 | Erica Guerrero | Physician Assistant | 4801 Alberta Ave Ste B-3200, El Paso, TX 79905-2707 | 2018-11-06 |
| 1366919391 | Jeffrey Aaron Hobbs | Physician Assistant | 5005 N. Piedras Street, Attn;, Wbamc, El Paso, TX 79920-5001 | 2018-10-29 |
| 1720580764 | Sungil Hwang | Physician Assistant | 11200 Sean Haggerty Dr Apt 18208, El Paso, TX 79934-3386 | 2018-03-06 |
| Find all providers in EL PASO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.