Healthcare Provider Details

I. General information

NPI: 1851614531
Provider Name (Legal Business Name): HOLLY D KIMBRELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 05/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 REDMOND RD NW EMERGENCY DEPARTMENT
ROME GA
30165-1415
US

IV. Provider business mailing address

PO BOX 162970
ATLANTA GA
30321-2970
US

V. Phone/Fax

Practice location:
  • Phone: 706-291-0291
  • Fax:
Mailing address:
  • Phone: 800-443-3670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN123684
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN123684
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: