MRS. KIMBERLY LAVERNE OBIDIEGWU (NPI# 1083228738) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083228738 |
| Entity Type | Individual |
| Full Name | MRS. KIMBERLY LAVERNE OBIDIEGWU |
| Credential | PA |
| Practice Address |
1207 E Herndon Ave Fresno CA 93720-3235 |
| Mailing Address |
40370 Road 222 Bass Lake CA 93604-9702 |
| Practice Telephone | 5594324303 |
| Mailing Telephone | 5597797438 |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2020-09-01 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PENDING | CA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1207 E HERNDON AVE |
| City | FRESNO |
| State | CA |
| Zip Code | 93720-3235 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508835463 | Rohit Sundrani | Internal Medicine | 1207 E Herndon Ave, Fresno, CA 93720-3235 | 2006-03-14 |
| 1063901742 | Mark A. De Los Santos | Nurse Practitioner | 1207 E Herndon Ave, Fresno, CA 93720-3235 | 2018-05-08 |
| 1811373897 | Karanvir Kaur | Nurse Practitioner | 1207 E Herndon Ave, Fresno, CA 93720-3235 | 2015-08-03 |
| 1700227030 | Amanda A. Tymn | Nurse Practitioner | 1207 E Herndon Ave, Fresno, CA 93720-3235 | 2013-07-15 |
| 1871802546 | Natasha Elizabeth Cogdill | Nurse Practitioner | 1207 E Herndon Ave, Fresno, CA 93720-3235 | 2010-09-29 |
| 1154541639 | Sandra Sullivan | Registered Nurse | 1207 E Herndon Ave, Fresno, CA 93720-3235 | 2007-04-26 |
| 1598817660 | Robert Alan Shows | Internal Medicine | 1207 E Herndon Ave, Fresno, CA 93720-3235 | 2007-01-17 |
| 1770592578 | Usman Javed | Internal Medicine | 1207 E Herndon Ave, Fresno, CA 93720-3235 | 2006-08-08 |
| 1811928039 | Lisa Marie Walter | Physician Assistant | 1207 E Herndon Ave, Fresno, CA 93720-3235 | 2006-07-05 |
| 1609845189 | William Edward Hanks | Internal Medicine | 1207 E Herndon Ave, Fresno, CA 93720-3235 | 2006-03-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366061129 | Ariel Lok Yen Leung | Student in an Organized Health Care Education/Training Program | 1313 East Herndon Ave, St 105, Fresno, CA 93720 | 2020-04-13 |
| 1457992513 | Brittany Nichole Willis | Audiologist | 1351 E Spruce Ave Ste 130, Fresno, CA 93720 | 2019-09-30 |
| 1013567668 | Taylor Courteney Cox | Physical Therapist | 7080 N. Maple Ave #101, Fresno, CA 93720 | 2019-09-16 |
| 1457909152 | Lillian M Augilera | Technician | 8419 N Dearing Ave, Fresno, CA 93720 | 2019-08-27 |
| 1215581764 | Sterling Hospitalist Medical Group, Inc. | Clinic/Center | 1191 E. Herndon Avenue Suite 103, Fresno, CA 93720 | 2019-08-01 |
| 1376006429 | Nancy Minh Thao Dang | Student in an Organized Health Care Education/Training Program | 1313 E. Herndon Ave, St 105, Fresno, CA 93720 | 2019-04-06 |
| 1366904716 | Shankar Nair | Student in an Organized Health Care Education/Training Program | 1313 E. Herndon Ave, St 105., Fresno, CA 93720 | 2019-04-04 |
| 1861979544 | Powell Pediatric Dentistry Chestnut Partnership | Dentist | 7005 N. Chestnut Ave Ste 101, Fresno, CA 93720 | 2018-07-25 |
| 1669967311 | Sierra Pacific Orthopaedic Center Medical Group Inc | Specialist | 1270 E. Spruce, Fresno, CA 93720 | 2018-06-26 |
| 1689168700 | Vinita Vishnoi | Student in an Organized Health Care Education/Training Program | 1313 E. Herndon Ave, St 105, Fresno, CA 93720 | 2018-06-21 |
| Find all providers in zip 93720 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356951057 | Sylvia Kim Hinton | Physician Assistant | 4085 N Peach Ave Apt 204, Fresno, CA 93727-8416 | 2020-08-06 |
| 1790300721 | Cayla Marie Clark | Physician Assistant | 4523 N Sunnyside Ave, Fresno, CA 93727-7265 | 2020-06-16 |
| 1720601396 | Cynthia Thompson | Physician Assistant | 699 E Portland Ave, Fresno, CA 93720-2114 | 2020-05-18 |
| 1679124507 | Folawemimo Eve Oluwaseun Onigbinde | Physician Assistant | 1131 Noble Glen Dr, Fresno, TX 77545-9689 | 2019-09-23 |
| 1194380253 | Edgar Ivan Mercado | Physician Assistant | 1350 O St Ste 202, Fresno, CA 93721-1828 | 2019-05-04 |
| 1255892683 | Stephanie Tran | Physician Assistant | 6700 N 1st St Ste 131, Fresno, CA 93710-3947 | 2019-03-28 |
| 1942624473 | Konducive Concepts | Physician Assistant | 4006 Dogwood Bough Ln, Fresno, TX 77545-7128 | 2014-02-04 |
| 1568891729 | Robert Ginther | Physician Assistant | 1300 N Fresno St Ste 220, Fresno, CA 93703-3843 | 2013-11-07 |
| 1134472707 | Isaac Gutierrez | Physician Assistant | 4105 W Swift Ave Ste 101, Fresno, CA 93722-6386 | 2012-10-19 |
| 1598033078 | Omni Women's Health Medical Group | Physician Assistant | 3612 N. First St., Fresno, CA 93726 | 2011-12-12 |
| Find all providers in FRESNO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.