Kimberly Gilliam Grant, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

9109580 Issued in FL

Practice address

6107 N 1St St Ste 103
Fresno, CA 93710-5460

Phone

(559) 432-4963

NPI assigned

Feb 28, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

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

Practice roles

Locations

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.

• Camarena Health

  • Federally Qualified Health Center (FQHC)
  • Los Banos, CA
  • NPI 1114757754
  NPD
• Camarena Health

  • Urgent Care Clinic/Center
  • Madera, CA
  • NPI 1194279554
  NPD
• Gail Mallard Warren MD Inc

  • Obstetrics & Gynecology Physician
  • Fresno, CA
  • NPI 1508946831
  NPD (past)
• Omni Family Health

  • Federally Qualified Health Center (FQHC)
  • Tehachapi, CA
  • NPI 1851325021
  NPD (past)

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

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588723200000",
    "number": "1871569855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6107 N 1ST ST STE 103",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937105460",
            "telephone_number": "559-432-4963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6107 N 1ST ST STE 103",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937105460",
            "telephone_number": "559-432-4963"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1590 Freedom Blvd",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Florence",
            "state": "SC",
            "postal_code": "295056040",
            "country_code": "US",
            "telephone_number": "843-629-1791",
            "fax_number": "843-629-1794",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1718 Mockingbird Ln",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "33801",
            "country_code": "US",
            "telephone_number": "863-272-1550",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRANT",
        "first_name": "KIMBERLY",
        "middle_name": "GILLIAM",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-28",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "PA642",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "9109580",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SC",
            "license": "TL1232",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0576APA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard Granese, M.D.
• Granite Ridge Home Health Nursing Care, Inc.
• Adam Michael Grant, DDS
• Anna Marie Grant
• Craig Edward Grant
• Laura Dawn Grant
• Shawnriel a. Grant
• Steven Grapperhaus
• Albert C Grasso, LCSW
• Jason Gravano, PH.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 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.