Provider Demographics
NPI:1689285777
Name:KIMBLE, DANYELLE
Entity Type:Individual
Prefix:DR
First Name:DANYELLE
Middle Name:
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 HIGHWAY 43 S
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-9297
Mailing Address - Country:US
Mailing Address - Phone:601-889-9509
Mailing Address - Fax:
Practice Address - Street 1:1505 HIGHWAY 43 S
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-9297
Practice Address - Country:US
Practice Address - Phone:601-889-9509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-15160183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist