Provider Demographics
NPI:1780849521
Name:TROMBLY, KIMBERLY COREY (NP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:COREY
Last Name:TROMBLY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CRITTENDEN BOULEVARD BOX PSYCH
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-3569
Mailing Address - Fax:585-273-1384
Practice Address - Street 1:300 CRITTENDEN BOULEVARD BOX PSYCH
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-3569
Practice Address - Fax:585-273-1384
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2019-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY430174363LA2100X
NYF430174363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care