Individual
NICOLE KIMBALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C, CAQ-OBGYN
Contact information
Practice address
173 SAINT PAUL ST, BURLINGTON, VT 05401-4636
(866) 476-1321
Mailing address
784 HERCULES DR STE 110, COLCHESTER, VT 05446-8049
(802) 448-9787
(802) 448-9787
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
055.0031689
VT
363A00000X
Physician Assistant
PA59084
CA
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
055.0031689
VT STATE LICENSE - PA
VT
05
—
6714044
—
VT
Enumeration date
10/25/2019
Last updated
05/13/2026
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