Provider Demographics
NPI:1184868101
Name:KIMZEY, NICOLE A (DO)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:A
Last Name:KIMZEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 SYCAMORE RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4407
Mailing Address - Country:US
Mailing Address - Phone:215-219-2683
Mailing Address - Fax:215-724-1652
Practice Address - Street 1:2625 W GIRARD AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19130-1333
Practice Address - Country:US
Practice Address - Phone:215-724-0517
Practice Address - Fax:215-724-1652
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013278207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine