Provider Demographics
NPI:1467895722
Name:KIMMES, ADAM WILLIAM (RN-BC)
Entity Type:Individual
Prefix:PROF
First Name:ADAM
Middle Name:WILLIAM
Last Name:KIMMES
Suffix:
Gender:M
Credentials:RN-BC
Other - Prefix:DR
Other - First Name:ADAM
Other - Middle Name:
Other - Last Name:KIMMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18 COBBLESTONE LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-5089
Mailing Address - Country:US
Mailing Address - Phone:702-743-6402
Mailing Address - Fax:
Practice Address - Street 1:18 COBBLESTONE LN
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-5089
Practice Address - Country:US
Practice Address - Phone:845-883-8083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY635414163WG0000X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health