Healthcare Provider Details

I. General information

NPI: 1265521249
Provider Name (Legal Business Name): TIM ALLEN KIMBRELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 FORT ROOTS DRIVE BLDG 170 UNIT 2H
NORTH LITTLE ROCK AR
72114
US

IV. Provider business mailing address

2200 FORT ROOTS DR BLDG 170 UNIT 2H
NORTH LITTLE ROCK AR
72114-1709
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-3468
  • Fax: 501-257-3125
Mailing address:
  • Phone: 501-257-3468
  • Fax: 501-257-3125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC-7938
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: