MEDICARE: KIMBERLY SAMUEL FNP

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	1-120233	AL
2	363LF0000X	Family Nurse Practitioner	1120233	AL

General Provider Information

NPI Number	:	1578984951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY SAMUEL FNP

Provider Business Mailing Address
First Line	:	1625 WOLVERINE DR SE
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35601-4933
Country	:	US
Telephone Number	:	256-333-1997
Fax Number	:	256-303-5007

Provider Business Practice Location Address
First Line	:	1625 WOLVERINE DR SE
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35601-4933
Country	:	US
Telephone Number	:	256-333-1997
Fax Number	:	256-303-5007

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

Provider Enumeration Date	:	01/02/2014
Last Update Date	:	04/16/2024

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Directions to “ KIMBERLY SAMUEL FNP” Practice Location

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