Provider Demographics
NPI:1558628560
Name:KIMMEL, AMY L
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:KIMMEL
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 1:2618 OLD BAINBRIDGE RD APT D
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-3554
Mailing Address - Country:US
Mailing Address - Phone:850-491-5807
Mailing Address - Fax:
Practice Address - Street 1:2618 OLD BAINBRIDGE RD APT D
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-3554
Practice Address - Country:US
Practice Address - Phone:850-491-5807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-15
Last Update Date:2012-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula