Individual
BONNELIA M KIMBLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
6420 DUTCHMANS PKWY, SUITE 200, LOUISVILLE, KY 40205-3372
(502) 891-8300
(502) 891-8338
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3004268
KY
363L00000X
Nurse Practitioner
4268P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000533456
ANTHEM PIN
KY
01
—
000000693047
ANTHEM - NCVA
KY
01
—
000057080V
HUMANA - NCVA
KY
01
—
122023
SIHO - NCVA
KY
05
—
7100147010
—
KY
01
—
P00992186
RAILROAD MEDICARE - KY
KY
Enumeration date
07/23/2006
Last updated
01/20/2021
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