Provider Demographics
NPI:1710396395
Name:KIMLER, CASEY M (APN)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:M
Last Name:KIMLER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:IL
Mailing Address - Zip Code:61523-2059
Mailing Address - Country:US
Mailing Address - Phone:309-677-0645
Mailing Address - Fax:309-683-5928
Practice Address - Street 1:319 N 4TH ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:IL
Practice Address - Zip Code:61523-2059
Practice Address - Country:US
Practice Address - Phone:309-677-0645
Practice Address - Fax:309-683-5928
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-011689363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner