Healthcare Provider Details

I. General information

NPI: 1659116523
Provider Name (Legal Business Name): ALICIA KIMBALL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 GILFORD AVE
GILFORD NH
03249-7500
US

IV. Provider business mailing address

107 GILFORD AVE
LACONIA NH
03246-2834
US

V. Phone/Fax

Practice location:
  • Phone: 603-556-4409
  • Fax: 833-909-3971
Mailing address:
  • Phone: 207-690-5697
  • Fax: 207-466-8753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number077414-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: