Provider Demographics
NPI:1083391718
Name:KIMBLER, KENDYL (PA-C)
Entity Type:Individual
Prefix:
First Name:KENDYL
Middle Name:
Last Name:KIMBLER
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 1:8623 EMPIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-6880
Mailing Address - Country:US
Mailing Address - Phone:940-597-5075
Mailing Address - Fax:
Practice Address - Street 1:3550 PARKWOOD BLVD STE 600
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1915
Practice Address - Country:US
Practice Address - Phone:972-377-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-04
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA16944363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant