Healthcare Provider Details

I. General information

NPI: 1326674615
Provider Name (Legal Business Name): MEGGAN ASHLEY KIMBALL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 NORTHWEST DR
PLAINVILLE CT
06062-1534
US

IV. Provider business mailing address

1676 FLANDERS RD
SOUTHINGTON CT
06489-1606
US

V. Phone/Fax

Practice location:
  • Phone: 860-793-3717
  • Fax:
Mailing address:
  • Phone: 508-409-7414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number83980
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: