Provider Demographics
NPI:1114148541
Name:KIMMER, BRYAN PAUL
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:PAUL
Last Name:KIMMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-3159
Mailing Address - Country:US
Mailing Address - Phone:870-793-2311
Mailing Address - Fax:870-793-8945
Practice Address - Street 1:1355 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-3159
Practice Address - Country:US
Practice Address - Phone:870-793-2311
Practice Address - Fax:870-793-8945
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator