Provider Demographics
NPI:1962973404
Name:KIMMEL, VICKIE JO
Entity type:Individual
Prefix:MS
First Name:VICKIE
Middle Name:JO
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 1:2 DORCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-2608
Mailing Address - Country:US
Mailing Address - Phone:618-920-8344
Mailing Address - Fax:
Practice Address - Street 1:2 DORCHESTER DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-2608
Practice Address - Country:US
Practice Address - Phone:618-920-8344
Practice Address - Fax:618-857-2111
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)