Provider Demographics
NPI:1801480314
Name:KIMBALL, EMILY DAWN (WHNP-BC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:DAWN
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:DAWN
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP-BC
Mailing Address - Street 1:4815 LIBERTY AVE STE GR25
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2156
Mailing Address - Country:US
Mailing Address - Phone:855-281-4963
Mailing Address - Fax:
Practice Address - Street 1:4815 LIBERTY AVE STE GR25
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:855-281-4963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP023331363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty