Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kimberly A Mizack, PA

Individual provider Physician Assistant · NPI 1639251762

Kimberly A Mizack, PA is a Physician Assistant in Salem, Virginia. Qualified in 2006, 20 years ago. Practices with Lewis Gale Physicians LLC, a 194-clinician group and accepts Medicare assignment. Licensed in Virginia.

Years since qualifying
20
Licensed in
VA
In the registry since
2006
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1802 Braeburn Dr
Salem, VA 24153-7357
Phone: (540) 772-3530
Fax: (540) 776-2036
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 0110002410 (VA)

Record details

NPI number1639251762
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedOctober 19, 2006
Last updated in NPPESFebruary 10, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2006 (20 years in practice)
Group practice Lewis Gale Physicians Llc — 194 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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