Provider Demographics
NPI:1194585117
Name:KIMBLE, HEATHER ANNE
Entity type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:ANNE
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 S LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-2026
Mailing Address - Country:US
Mailing Address - Phone:269-625-1911
Mailing Address - Fax:
Practice Address - Street 1:628 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-2026
Practice Address - Country:US
Practice Address - Phone:269-625-1911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care