Provider Demographics
NPI:1831715804
Name:KIMBRELL, WILLIAM DOLPHUS IV (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DOLPHUS
Last Name:KIMBRELL
Suffix:IV
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 DOVEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32534-9769
Mailing Address - Country:US
Mailing Address - Phone:850-503-3625
Mailing Address - Fax:
Practice Address - Street 1:7552 NAVARRE PKWY UNIT 28
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-7308
Practice Address - Country:US
Practice Address - Phone:850-939-3999
Practice Address - Fax:850-939-3935
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11007751363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11007751OtherADVANCED PRACTICE REGISTERED NURSE