Provider Demographics
NPI:1891054797
Name:KIMPLE, ADAM JORDAN (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JORDAN
Last Name:KIMPLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 MANNING DR # 7070
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4221
Mailing Address - Country:US
Mailing Address - Phone:919-966-6484
Mailing Address - Fax:
Practice Address - Street 1:170 MANNING DR # 7070
Practice Address - Street 2:DEPT. OTOLARYNGOLOGY, ROOM G190
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4221
Practice Address - Country:US
Practice Address - Phone:919-966-6484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC182240390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program