Healthcare Provider Details

I. General information

NPI: 1104332576
Provider Name (Legal Business Name): ASHELEY DAWN KIMBLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 12/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

592 LINDO AVE
CHICO CA
95926
US

IV. Provider business mailing address

1451 ROCKY RIDGE DR APT 1112
ROSEVILLE CA
95661-3007
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-2775
  • Fax:
Mailing address:
  • Phone: 810-288-5884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95132543
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: