Healthcare Provider Details

I. General information

NPI: 1699353946
Provider Name (Legal Business Name): STUART IAIN KIMBALL NREMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 ANDREW CHAPEL RD
STAFFORD VA
22554-5522
US

IV. Provider business mailing address

180 SUMMER BREEZE LN
FREDERICKSBURG VA
22406-5037
US

V. Phone/Fax

Practice location:
  • Phone: 540-498-0359
  • Fax:
Mailing address:
  • Phone: 540-498-0359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberB201604112
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: