Provider Demographics
NPI:1265725196
Name:KIMBRELL, JENNIFER MARIE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:KIMBRELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:MARLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1720 2ND AVE S
Mailing Address - Street 2:CH19 SUITE 307
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-2041
Mailing Address - Country:US
Mailing Address - Phone:205-934-7027
Mailing Address - Fax:205-996-7902
Practice Address - Street 1:930 20TH ST S
Practice Address - Street 2:CH20 SUITE 140
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-2610
Practice Address - Country:US
Practice Address - Phone:205-934-7027
Practice Address - Fax:205-996-7902
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-118391163WG0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL131694Medicaid