Provider Demographics
NPI:1962602573
Name:KIMBLE, LINDA (APRN -BC PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:APRN -BC PMHNP-BC
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:KIMBLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC APRN-BC
Mailing Address - Street 1:4336 ORCHARDVIEW DR SE
Mailing Address - Street 2:
Mailing Address - City:EAST CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44730-9513
Mailing Address - Country:US
Mailing Address - Phone:330-488-6083
Mailing Address - Fax:330-488-6083
Practice Address - Street 1:675 HOBBY HORSE LN
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-1461
Practice Address - Country:US
Practice Address - Phone:513-443-1700
Practice Address - Fax:855-919-6229
Is Sole Proprietor?:No
Enumeration Date:2007-07-21
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN192334163WP0809X, 363LA2200X
OHRN192334-07560363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2958456Medicaid
OHNP31051Medicare UPIN