Kimberly Elaine Connor, PA-C, CLE

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

349 Issued in WV

Practice address

110 Sims Circle
Triadelphia, WV 26059-1154

Phone

(304) 599-8000

Fax

(304) 599-8003

NPI assigned

Jan 10, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: connor.kimberly.002.0480018@ohvmc.meditab.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cardinal Pediatrics PLLC

  • Pediatrics Physician
  • Morgantown, WV
  • NPI 1548272651
  NPD (past)

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

{
    "created_epoch": "1294617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612396800000",
    "number": "1174827893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1247 SUNCREST TOWN CENTRE DR",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265051876",
            "telephone_number": "304-599-8000",
            "fax_number": "304-599-8003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 SIMS CIRCLE",
            "city": "TRIADELPHIA",
            "state": "WV",
            "postal_code": "260591154",
            "telephone_number": "304-599-8000",
            "fax_number": "304-599-8003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOR",
        "first_name": "KIMBERLY",
        "middle_name": "ELAINE",
        "name_prefix": "Mrs.",
        "credential": "PA-C, CLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-10",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174N00000X",
            "taxonomy_group": "",
            "desc": "Lactation Consultant, Non-RN",
            "state": null,
            "license": "L-41918",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "349",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174827893",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018811",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Behavioral Health Assessments PLLC
• Aric Beihl
• Beth L Bittinger, PA
• Careconnectmd West Virginia Corp
• Jamie Coen-Pickens
• Holly Kelly Coville, M.A., ED.S.
• Taylor Christine Croft, DPT
• Austin Scott Cusick, DO
• Mary Rachel Davis
• Mary Kay Debeni

• Physician Assistant in Triadelphia, WV
• Providers in Triadelphia, WV by specialty
• Physician Assistant in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.