Active NPI
Kimberly Kannenberg, PA-C
- Physician Assistant
- Delray Beach, FL
National Provider Identifier
1265777544
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 9106163
- Practice address
- 1425 S Congress Ave
Delray Beach, FL 33445-6384 - Phone
- (561) 330-9363
- NPI assigned
- Nov 28, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 9106163 | FL | Primary |
| Physician Assistant | 363A00000X | 00269 | TX |
Addresses
Primary practice location
1425 S Congress Ave
Delray Beach, FL 33445-6384
Mailing address
1425 South Congress Avenue
Delray Beach, FL 33445
Phone (561) 330-9363
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9106163 | FL | MD | Physician Assistant |
| 00269 | TX | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1354060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370822400000",
"number": "1265777544",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1425 SOUTH CONGRESS AVENUE",
"city": "DELRAY BEACH",
"state": "FL",
"postal_code": "33445",
"telephone_number": "561-330-9363"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1425 S CONGRESS AVE",
"city": "DELRAY BEACH",
"state": "FL",
"postal_code": "334456384",
"telephone_number": "561-330-9363"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANNENBERG",
"first_name": "KIMBERLY",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-11-28",
"last_updated": "2013-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "9106163",
"primary": true
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "00269",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Delray Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.