Healthcare Provider Details

I. General information

NPI: 1427452119
Provider Name (Legal Business Name): KIMBRA CLICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 JOLIET ST
DYER IN
46311-1705
US

IV. Provider business mailing address

3009 TOPAZ DR
HOBART IN
46342-6544
US

V. Phone/Fax

Practice location:
  • Phone: 219-865-2141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28141131-A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: