Kimberly Joy Kinnebrew, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

408 Issued in AK

Practice address

12350 Industry Way Ste 110
Anchorage, AK 99515-4301

Phone

(907) 206-9114

Fax

(907) 206-7009

NPI assigned

Jun 28, 2006

Last updated

May 25, 2022By 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

Enrolled in AK

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

University of Washington School of Medicine, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Alaska Medical Center Hospital, Anchorage, AK, CCN 020001

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

• Alaskin Dermatology LLC

  • Dermatology Physician
  • Anchorage, AK
  • NPI 1790423135
  Medicare reassignment Authorized official

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Providence Health & Services Washington

  dba Providence Alaska Medical Center

  • General Acute Care Hospital
  • Anchorage, AK
  • NPI 1053363119
  Care Compare affiliation

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653436800000",
    "number": "1437186889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12350 INDUSTRY WAY STE 110",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995154301",
            "telephone_number": "907-206-9114",
            "fax_number": "907-206-7009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12350 INDUSTRY WAY STE 110",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995154301",
            "telephone_number": "907-206-9114",
            "fax_number": "907-206-7009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINNEBREW",
        "first_name": "KIMBERLY",
        "middle_name": "JOY",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-28",
        "last_updated": "2022-05-25",
        "certification_date": "2022-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60953898",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AK",
            "license": "408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheila R King, CHT-OTR/L
• Leigh Marie Kingsbury
• Trever Kingsbury, PT, DPT
• David Kingston, PA-C
• Edwin Kinisu, MBA
• Amber May Kinney
• Hannah Layne Kinney, OTD, OTR/L
• Korey Kinney, DPT
• Maria Carmen Kinney, RN
• Ryne Dale Kinney, CT

• Medical Physician Assistant in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Medical Physician Assistant in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.