MEDICARE: RILEY PAUL KIMBALL MSN, FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN.CNP.0039219	OH
2	163W00000X	Registered Nurse	RN728353	PA
3	363LP2300X	Primary Care Nurse Practitioner	SP032785	PA

General Provider Information

NPI Number	:	1437947348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RILEY PAUL KIMBALL MSN, FNP-BC

Provider Business Mailing Address
First Line	:	636 W EXCHANGE ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44302-1306
Country	:	US
Telephone Number	:	833-378-4827
Fax Number	:

Provider Business Practice Location Address
First Line	:	636 W EXCHANGE ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44302-1306
Country	:	US
Telephone Number	:	330-409-9505
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2025
Last Update Date	:	10/20/2025

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