Provider Demographics
NPI:1619838406
Name:KIMBALL, TAMARA
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:KIMBALL
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 1:3150 ENTERPRISE DR # 200
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2310
Mailing Address - Country:US
Mailing Address - Phone:989-249-0929
Mailing Address - Fax:810-309-9627
Practice Address - Street 1:3150 ENTERPRISE DR # 200
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2310
Practice Address - Country:US
Practice Address - Phone:989-249-0929
Practice Address - Fax:810-309-9627
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-20
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker