Provider Demographics
NPI:1952400657
Name:YARNALL, KIMBERLY S (DC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:S
Last Name:YARNALL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PLAZA CT
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8263
Mailing Address - Country:US
Mailing Address - Phone:570-421-7020
Mailing Address - Fax:
Practice Address - Street 1:600 PLAZA CT
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8263
Practice Address - Country:US
Practice Address - Phone:570-517-0511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007587L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017615820001Medicaid
PA800017119OtherASHN
PA60937OtherGEISNGER
PAFI595237OtherBLUE CROSS
PAP3399574OtherOXFORD
PA7185168OtherAETNA
PA814648OtherFIRST PRIORITY HEALTH