Healthcare Provider Details

I. General information

NPI: 1427212976
Provider Name (Legal Business Name): REBECCA ELAINE KIMBELL MSN, APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA ELAINE KIMBELL-FARRIS MSN, APRN, CNP

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 KIDWELL DR
VERSAILLES MO
65084-1787
US

IV. Provider business mailing address

801 KIDWELL DR
VERSAILLES MO
65084-1787
US

V. Phone/Fax

Practice location:
  • Phone: 573-378-5454
  • Fax: 573-378-5055
Mailing address:
  • Phone: 573-378-5454
  • Fax: 573-378-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0063706
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2013009202
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: