Provider Demographics
NPI:1346781549
Name:KIMBLE, CHELSEY B (DO)
Entity type:Individual
Prefix:DR
First Name:CHELSEY
Middle Name:B
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3382 PARIS BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4260
Mailing Address - Country:US
Mailing Address - Phone:614-882-2521
Mailing Address - Fax:614-882-0511
Practice Address - Street 1:3382 PARIS BLVD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-4260
Practice Address - Country:US
Practice Address - Phone:614-882-2521
Practice Address - Fax:614-882-0511
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.014765207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0229768Medicaid