Provider Demographics
NPI:1821090283
Name:RAICHEL, KIMBERLY (ARNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:RAICHEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 BLACK GOLD BLVD
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-2603
Mailing Address - Country:US
Mailing Address - Phone:606-436-0711
Mailing Address - Fax:606-436-0848
Practice Address - Street 1:210 BLACK GOLD BLVD
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-2603
Practice Address - Country:US
Practice Address - Phone:606-436-0711
Practice Address - Fax:606-436-0848
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4350P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78013265Medicaid
KYQ30645Medicare UPIN
KY1261935Medicare PIN
KY0077283Medicare PIN
KY78013265Medicaid