Vonderlieth, Kimberly Ann

Vonderlieth, Kimberly Ann is an sole proprietor health care provider with primary practice located at 1350 Hickory St , Melbourne FL 32901-3224. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Surgical is her primary health care specialty. Vonderlieth, Kimberly Ann can be contacted via phone (321) 434-1401.

Contact Information

Primary practice address
1350 Hickory St Melbourne FL 32901-3224
Phone: (321) 434-1401
Fax: (321) 434-1667
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA9101648 Florida
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA9101648 Florida

Profile Details

NPI number 1396917522
LBN Legal business name Vonderlieth, Kimberly Ann
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 27th, 2008
Last updated Jan 17th, 2024 - about 11 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396917522 NPPES
Florida Other LS853 FL MEDICARE
Florida MEDICAID 104257000 FL MEDICARE
Florida Other LY388 FL MEDICARE

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