MEDICARE: MICHELLE DENISE KIMBRELL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSWS1282	AK
2	1041C0700X	Clinical Social Worker	113991	TX

General Provider Information

NPI Number	:	1811761216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE DENISE KIMBRELL LCSW

Provider Business Mailing Address
First Line	:	3220 KHYBER CIR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99504-3957
Country	:	US
Telephone Number	:	907-830-6112
Fax Number	:

Provider Business Practice Location Address
First Line	:	3220 KHYBER CIR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99504-3957
Country	:	US
Telephone Number	:	907-830-6112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2023
Last Update Date	:	03/02/2026

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