Provider Demographics
NPI:1174864516
Name:KIMBLER, AMANDA DENISE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:DENISE
Last Name:KIMBLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-2337
Mailing Address - Country:US
Mailing Address - Phone:270-251-3223
Mailing Address - Fax:270-251-3220
Practice Address - Street 1:318 S 7TH ST
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-2337
Practice Address - Country:US
Practice Address - Phone:270-251-3223
Practice Address - Fax:270-251-3220
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007992363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1122485OtherNURSE
KY7100090880OtherMEDICAID GROUP
KY253582OtherCOVENTRY--MEDICAID
KY3007992OtherAPRN LIC
KY7100242550Medicaid
KY00975OtherMEDICARE GROUP
KY00975OtherMEDICARE GROUP