Individual
MRS. KIMBERLY B. FOGARTY
Active
Individual
MRS. KIMBERLY B. FOGARTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110001588
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0110001588
LICENSE
VA
01
—
145453
LICENSE
NC
01
—
PA030663
LICENSE
DC
Enumeration date
10/03/2006
Last updated
03/07/2023
Update your record
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