Healthcare Provider Details

I. General information

NPI: 1154887677
Provider Name (Legal Business Name): DANA A KIMBRELL NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 06/08/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 W 7TH ST
DOVER OH
44622-2813
US

IV. Provider business mailing address

407 W 7TH ST
DOVER OH
44622-2813
US

V. Phone/Fax

Practice location:
  • Phone: 330-432-5750
  • Fax:
Mailing address:
  • Phone: 330-432-5750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLE-00026665
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number024661
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.024661
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: