Provider Demographics
NPI:1013604537
Name:KIMLER, JESSICA H (CLC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:H
Last Name:KIMLER
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 US HIGHWAY 13 N
Mailing Address - Street 2:
Mailing Address - City:GATES
Mailing Address - State:NC
Mailing Address - Zip Code:27937-9493
Mailing Address - Country:US
Mailing Address - Phone:757-297-7736
Mailing Address - Fax:
Practice Address - Street 1:525 US HIGHWAY 13 N
Practice Address - Street 2:
Practice Address - City:GATES
Practice Address - State:NC
Practice Address - Zip Code:27937-9493
Practice Address - Country:US
Practice Address - Phone:757-297-7736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MD342126174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program