Provider Demographics
NPI:1508091919
Name:KIMPLE, KELLY SMITH (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:SMITH
Last Name:KIMPLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:231 MACNIDER HALL
Mailing Address - Street 2:CAMPUS BOX 7225
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599
Mailing Address - Country:US
Mailing Address - Phone:919-966-1072
Mailing Address - Fax:919-966-8419
Practice Address - Street 1:101 MANNING DR.
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599
Practice Address - Country:US
Practice Address - Phone:919-966-2504
Practice Address - Fax:919-966-3852
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-01050208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics