Provider Demographics
NPI:1215636550
Name:FIMPLE, KALLAN ELAINE
Entity type:Individual
Prefix:MRS
First Name:KALLAN
Middle Name:ELAINE
Last Name:FIMPLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KALLAN
Other - Middle Name:ELAINE
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:172 QUINCY RD
Mailing Address - Street 2:
Mailing Address - City:KIRBYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65679-9319
Mailing Address - Country:US
Mailing Address - Phone:918-645-0579
Mailing Address - Fax:
Practice Address - Street 1:1630 E PRIMROSE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7929
Practice Address - Country:US
Practice Address - Phone:417-885-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023004369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist