Provider Demographics
NPI:1780302141
Name:KIMPEL, JULIE (PA-C)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:KIMPEL
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 W 440 S
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-3749
Mailing Address - Country:US
Mailing Address - Phone:208-201-0387
Mailing Address - Fax:
Practice Address - Street 1:205 N BERKLEY ST
Practice Address - Street 2:
Practice Address - City:COUNCIL
Practice Address - State:ID
Practice Address - Zip Code:83612-5015
Practice Address - Country:US
Practice Address - Phone:208-253-4242
Practice Address - Fax:208-253-6849
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6461975363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant