Provider Demographics
NPI:1780024125
Name:KIMBELL, KAYLA (DO)
Entity Type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:
Last Name:KIMBELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:BLITON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 78866
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53278-8866
Mailing Address - Country:US
Mailing Address - Phone:779-696-7150
Mailing Address - Fax:
Practice Address - Street 1:5665 N JUNCTION WAY
Practice Address - Street 2:
Practice Address - City:DAVIS JUNCTION
Practice Address - State:IL
Practice Address - Zip Code:61020-9433
Practice Address - Country:US
Practice Address - Phone:779-696-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-30
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020626207Q00000X
IL036-141879207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine