Provider Demographics
NPI:1912104266
Name:KIMPEL, NICHOLAS ALLEN (DO)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ALLEN
Last Name:KIMPEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 SAINT CLAIR DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:AL
Mailing Address - Zip Code:35761
Mailing Address - Country:US
Mailing Address - Phone:803-522-0953
Mailing Address - Fax:
Practice Address - Street 1:460 SAINT CLAIR DRIVE
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:AL
Practice Address - Zip Code:35761
Practice Address - Country:US
Practice Address - Phone:803-522-0953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARTP002340207P00000X
AL#DO1133207P00000X
GA062130207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine