Provider Demographics
NPI:1275892705
Name:KIMBRELL, JILLIAN (CFNP)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:KIMBRELL
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5709
Mailing Address - Country:US
Mailing Address - Phone:228-872-2403
Mailing Address - Fax:228-875-7584
Practice Address - Street 1:11 DOCTORS DR.
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564
Practice Address - Country:US
Practice Address - Phone:228-872-2403
Practice Address - Fax:228-875-7584
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR875384363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily