Individual
JIMMY RAY KIMBALL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3000 NEW BERN AVE, RALEIGH, NC 27610-1231
(919) 350-5645
Mailing address
PO BOX 18139, RALEIGH, NC 27619-8139
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
164911
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8052459
—
NC
01
—
P00293527
RAILROAD-MEDICARE
NC
Enumeration date
01/31/2007
Last updated
05/21/2008
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