Individual
BEVERLY A. KIMBALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1700 W STOUT ST, RICE LAKE, WI 54868-5000
(715) 236-8100
Mailing address
1000 N OAK AVE, MARSHFIELD, WI 54449-5703
(715) 387-5511
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
8905
MN
363A00000X
Physician Assistant
Primary
225-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41935200
—
WI
05
—
843159100
—
MN
Enumeration date
04/10/2006
Last updated
07/07/2010
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