Individual
KIMBERLY MALLICK FILLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
240 HOSPITAL DR NE, BOLIVIA, NC 28422-8346
(843) 497-5929
Mailing address
240 HOSPITAL DR NE, BOLIVIA, NC 28422-8346
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
101827
NC
363AM0700X
Medical Physician Assistant
Primary
101827
NC
Other
Enumeration date
07/26/2005
Last updated
07/15/2020
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