Individual
LESLIE RENEE KIMPLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 444-8715
(401) 444-8781
Mailing address
593 EDDY ST, APC 5, PROVIDENCE, RI 02903-4923
(401) 444-8715
(401) 444-8781
Taxonomy
Speciality
Code
Description
License number
State
2084A2900X
Neurocritical Care Physician
Primary
Q8926
TX
2084N0400X
Neurology Physician
40766
SC
2084N0400X
Neurology Physician
9407736
KS
2084N0400X
Neurology Physician
DO01257
RI
2084P0800X
Psychiatry Physician
Q8926
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00106W
GRP MEDICARE PTAN
TX
01
—
0035TD
BCBSTX GRP PROVIDER RECORD #
TX
01
—
153449704
GRP MEDICAID TPI #
TX
Enumeration date
06/29/2011
Last updated
06/29/2023
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