Healthcare Provider Details

I. General information

NPI: 1861531501
Provider Name (Legal Business Name): JILL ANN KIMM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 10/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 E JEFFERSON ST SUITE 301
IOWA CITY IA
52245-2477
US

IV. Provider business mailing address

PO BOX 2027
IOWA CITY IA
52244-2027
US

V. Phone/Fax

Practice location:
  • Phone: 319-688-7800
  • Fax: 319-887-2879
Mailing address:
  • Phone: 319-339-3541
  • Fax: 319-358-2737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberC53654
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberC53654
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number23341
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number24640
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberC53654
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: