Provider Demographics
NPI:1154887677
Name:KIMBRELL, DANA A (NP-C)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:A
Last Name:KIMBRELL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2813
Mailing Address - Country:US
Mailing Address - Phone:330-432-5750
Mailing Address - Fax:
Practice Address - Street 1:407 W 7TH ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2813
Practice Address - Country:US
Practice Address - Phone:330-432-5750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-20
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLE-00026665207Q00000X
OH024661207Q00000X
OHAPRN.CNP.024661363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH207Q00000XMedicaid