Basic Information
| Provider Information | |||||||||
| NPI: | 1366538696 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIMSEY | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 114 WESTMINSTER DR | ||||||||
| Address2: | |||||||||
| City: | RAINBOW CITY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359063704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2564424245 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1007 GOODYEAR AVE | ||||||||
| Address2: | |||||||||
| City: | GADSDEN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359031195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2564944132 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 12/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 1-092729 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 116669 | 05 | AL | MEDICAID |