Kimberly Laverne Obidiegwu, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PENDING Issued in CA

Practice address

1207 E Herndon Ave
Fresno, CA 93720-3235

Phone

(559) 432-4303

NPI assigned

Sep 1, 2020

Last updated

Sep 1, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: kimberly.obidiegwu.p1@direct.ciocc.nextgenshare.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1598918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598918400000",
    "number": "1083228738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40370 ROAD 222",
            "city": "BASS LAKE",
            "state": "CA",
            "postal_code": "936049702",
            "telephone_number": "559-779-7438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1207 E HERNDON AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937203235",
            "telephone_number": "559-432-4303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBIDIEGWU",
        "first_name": "KIMBERLY",
        "middle_name": "LAVERNE",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-01",
        "last_updated": "2020-09-01",
        "certification_date": "2020-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valine Obanwo
• Christine Akemi Obata, M.D.
• Kerri Oberti-Smith, CP
• Jack Matthew Oberti, DDS
• Michael R Oberto, MD
• Sandra Obianuju Obitte
• Marta B. Obler, MD
• Elizabeth Uzoamaka Obodoagha III
• Daizell Obong
• Qiaofei Obrero, PT, DPT

• Physician Assistant in Fresno, CA
• Providers in Fresno, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.