Individual provider Active NPI

Kimberly Ann Lafreniere, PA-C

  • Physician Assistant
  • Statesville, NC
National Provider Identifier
1790058691
Registry record updated Aug 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-03332 Issued in NC
Practice address
633 Brookdale Dive
Suite 300
Statesville, NC 28677-3403
Phone
(704) 873-3250
Fax
(704) 873-2940
NPI assigned
Feb 23, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-03332 NC Primary

Addresses

Primary practice location

633 Brookdale Dive
Suite 300
Statesville, NC 28677-3403

Mailing address

PO Box 1845
Statesville, NC 28687-1845
Phone (704) 873-3250

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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

Enrollment IDStateProvider typePAC IDDetails
I20120314000848 NC Practitioner - Physician Assistant 6204095011 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Piedmont Healthcare PAGroup PAC ID 9638070683, 226 clinicians

Practice addresses (Care Compare)

128 Medical Park Rd
Suite 102
Mooresville, NC 28117-8578
Phone (704) 978-3566

129 Sherlock Dr
Statesville, NC 28625-1916
Phone (704) 838-8245

138 Sherlock Dr
Statesville, NC 28625-1916
Phone (704) 873-1021

1404 Fern Creek Dr
Statesville, NC 28625-9376
Phone (704) 978-4025

142 Sherlock Dr
Statesville, NC 28625-1916
Phone (704) 838-8256

1424 B Fern Creek Dr
Statesville, NC 28625-9376
Phone (704) 872-0224

1446 Fern Creek Dr
Statesville, NC 28625-9376
Phone (704) 873-9617

152 Sherlock Dr
Statesville, NC 28625-1916
Phone (704) 838-8210

208 Old Mocksville Rd
Statesville, NC 28625-1930
Phone (704) 878-2011

357 Williamson Rd
Mooresville, NC 28117-5935
Phone (704) 664-7328

359 Williamson Rd
Mooresville, NC 28117-5935
Phone (704) 235-1838

517 Brookdale Dr
Statesville, NC 28677-4107
Phone (704) 872-4544

533 Brookdale Dr
Statesville, NC 28677-4107
Phone (704) 838-8249

633 Brookdale Dr
Statesville, NC 28677-3403

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0010-03332NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Piedmont Healthcare, P.a. CurrentSince Feb 13, 2012 Accepting new patients
Piedmont Healthcare, PA CurrentSince Feb 13, 2012 Accepting new patients

Locations

633 Brookdale Dr
Ste 300
Statesville, NC 28677
Phone (704) 873-3250

208 Old Mocksville Rd
Statesville, NC 28625
Phone (704) 838-8215

650 Signal Hill Drive Ext
Statesville, NC 28625
Phone (704) 873-4277

Organizations & group practices 2

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1329955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692057600000",
    "number": "1790058691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1845",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286871845",
            "telephone_number": "704-873-3250",
            "fax_number": "704-873-2940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 BROOKDALE DIVE",
            "address_2": "SUITE 300",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773403",
            "telephone_number": "704-873-3250",
            "fax_number": "704-873-2940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAFRENIERE",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-23",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-03332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesville, NC

Sources for this page

Verify at the official NPI Registry.