Individual
TANNER C KIMBLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CST/CSFA
Contact information
Practice address
2100 HIGHWAY 61 N, VICKSBURG, MS 39183-8211
(601) 883-5000
Mailing address
406 LACASA LOOP, TWIN FALLS, ID 83301-5663
(208) 410-0569
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
188016
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
188016
THE NATIONAL BOARD OF SURGICAL TECHNOLOGY AND SURGICAL ASSISTING
—
Enumeration date
09/02/2021
Last updated
02/15/2022
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