Provider Demographics
NPI:1497722391
Name:COLBURN, KIMBRELL L (PA)
Entity Type:Individual
Prefix:
First Name:KIMBRELL
Middle Name:L
Last Name:COLBURN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 SAINT VINCENTS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1636
Mailing Address - Country:US
Mailing Address - Phone:205-939-3000
Mailing Address - Fax:205-930-0008
Practice Address - Street 1:805 SAINT VINCENTS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1636
Practice Address - Country:US
Practice Address - Phone:205-939-3699
Practice Address - Fax:205-939-0989
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA7363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL42595Medicaid
AL51527784OtherBCBS
R51747Medicare UPIN
000042595Medicare ID - Type Unspecified