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General NPI Number Information
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NPI Number | 1316646797
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Entity Type | Individual
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Provider Name | CRYSTAL NOEL KIMBALL FNP, RN
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Gender | Female
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Dates
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Enumeration Date | 02/24/2023
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Last Update Date | 02/24/2023
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Provider Practice Location Address
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Address Line | 1050 N STATE ST
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City | UKIAH
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State | CA
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Zip | 95482-3414
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Country | US
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Telephone | 707-662-3111
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Fax |
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Provider Business Mailing Address
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Address Line | 880 SANEL DR
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City | UKIAH
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State | CA
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Zip | 95482-9604
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Country | US
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Telephone | 530-601-0314
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 95024333
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License Number State | CA
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