Kimberly Ann Churchill, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-04402 Issued in NC

Practice address

2001 Vail Ave
Suite 200
Charlotte, NC 28207-1248

Phone

(704) 323-2000

NPI assigned

Jul 31, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Kimberly Ann Gray Former name

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

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.

• CHS Anesthesia Services Group Inc

  • Anesthesiology Physician
  • Charlotte, NC
  • NPI 1346649415
  Medicare reassignment
• Surgical Specialists of Charlotte, P.a.

  • Surgery Physician
  • Charlotte, NC
  • NPI 1073599734
  Medicare reassignment

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

{
    "created_epoch": "1375228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644278400000",
    "number": "1912339052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 33369",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282333369",
            "telephone_number": "704-916-2108",
            "fax_number": "704-365-2073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 VAIL AVE",
            "address_2": "SUITE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071248",
            "telephone_number": "704-323-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHURCHILL",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-31",
        "last_updated": "2022-02-08",
        "certification_date": "2022-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-04402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "GRAY",
            "middle_name": "ANN",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ann Clay Church, MA
• Kerry A Church, M. S., CCC-SLP
• Laura B Church, PHARMD
• Lindsey Nicole Church, MSW, LCSW
• Nicole A. Church, BCBA
• David Anthony Ciaccia, DO
• Augusto Jorge Cianciabella, P.A.
• Jennifer Dehaven Cianciolo, LCSW
• Nelsa A Ciapponi, M.D.
• Joseph Ciccarello, PHARM.D., M.B.A.

• Physician Assistant in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.