Individual
JENNIFER S KIMBALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
77 BATES ST, STE 102, LEWISTON, ME 04240
(207) 783-2300
(207) 783-2439
Mailing address
77 BATES ST, STE 102, LEWISTON, ME 04240
(207) 783-2300
(207) 783-2439
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R045683
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010424957
CHAMPUS
—
01
—
047308
BCBS
—
01
—
250012128
MEDICARE RAILROAD GROUP
—
01
—
P0061
BCBS GROUP NUMBER
—
Enumeration date
02/21/2006
Last updated
04/28/2011
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