Provider Demographics
NPI:1447858196
Name:KIMBELL, MICHELLE (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:KIMBELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 REBECCA LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8333
Mailing Address - Country:US
Mailing Address - Phone:386-775-2012
Mailing Address - Fax:386-775-2013
Practice Address - Street 1:2745 REBECCA LN
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8333
Practice Address - Country:US
Practice Address - Phone:386-775-2012
Practice Address - Fax:386-775-2013
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant