Healthcare Provider Details

I. General information

NPI: 1831886746
Provider Name (Legal Business Name): JENNA KIMBLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 GOODWOOD BLVD STE 202
BATON ROUGE LA
70806-7851
US

IV. Provider business mailing address

2903 1ST AVE
LAKE CHARLES LA
70601-8897
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-8013
  • Fax: 225-765-2033
Mailing address:
  • Phone: 337-478-6480
  • Fax: 337-474-9637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number353803
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: