Provider Demographics
NPI:1811778343
Name:KIMBLE, KAYLA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:KIMBLE
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:WRASMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15398 COUNTY ROAD F75
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-9588
Mailing Address - Country:US
Mailing Address - Phone:419-303-0404
Mailing Address - Fax:
Practice Address - Street 1:705 N FAYETTE ST
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:OH
Practice Address - Zip Code:43521-9586
Practice Address - Country:US
Practice Address - Phone:419-765-4568
Practice Address - Fax:419-894-3889
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.008456RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant