Individual
MRS. CHERYL KIMMEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
77 W GRANADA BLVD, ORMOND BEACH, FL 32174-6302
(386) 677-0453
(386) 677-5494
Mailing address
1256 ROBBIN DR, PORT ORANGE, FL 32129-7426
(386) 756-4497
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9102863
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26863
BLUE CROSS BLUE SHIELD
FL
Enumeration date
10/18/2006
Last updated
04/15/2010
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