Basic Information
Provider Information
NPI: 1831554906
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KIMBLE
FirstName: APRIL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1839 CENTRAL AVE
Address2:  
City: ST PETERSBURG
State: FL
PostalCode: 337138900
CountryCode: US
TelephoneNumber: 7278201040
FaxNumber: 7278228081
Practice Location
Address1: 1839 CENTRAL AVE
Address2:  
City: ST PETERSBURG
State: FL
PostalCode: 337138900
CountryCode: US
TelephoneNumber: 7278201040
FaxNumber: 7278228081
Other Information
ProviderEnumerationDate: 12/16/2015
LastUpdateDate: 12/16/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2200X9288508FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health

No ID Information.


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