MEDICARE: JEFFERY R KIMBALL

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	374U00000X	Home Health Aide	04803	NH

General Provider Information

NPI Number	:	1568312338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFERY R KIMBALL

Provider Business Mailing Address
First Line	:	144 WHITE PLAINS RD
Second Line	:
City	:	WEBSTER
State	:	NH
Zip	:	03303-7206
Country	:	US
Telephone Number	:	603-738-1197
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 COUNTRY CLUB RD UNIT 503
Second Line	:
City	:	GILFORD
State	:	NH
Zip	:	03249-6977
Country	:	US
Telephone Number	:	603-738-1197
Fax Number	:

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

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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