Provider Demographics
NPI:1104566223
Name:KIMMEL, ALEXANDER NICHOLAS
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:NICHOLAS
Last Name:KIMMEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 NW VIVION RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-4555
Mailing Address - Country:US
Mailing Address - Phone:816-853-0946
Mailing Address - Fax:816-396-8809
Practice Address - Street 1:850 S LORRAINE AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-3028
Practice Address - Country:US
Practice Address - Phone:816-853-0946
Practice Address - Fax:816-396-8809
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-22-207745OtherBEHAVIOR ANALYST CERTIFICATION BOARD