MEDICARE: KAITLYN ALEXIS 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	2355S0801X	Speech-Language Assistant	44715	TX

General Provider Information

NPI Number	:	1598637704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN ALEXIS KIMBALL

Provider Business Mailing Address
First Line	:	1440 EASTOVER ST
Second Line	:
City	:	COLORADO CITY
State	:	TX
Zip	:	79512-4722
Country	:	US
Telephone Number	:	325-242-3015
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 EASTOVER ST
Second Line	:
City	:	COLORADO CITY
State	:	TX
Zip	:	79512-4722
Country	:	US
Telephone Number	:	325-242-3015
Fax Number	:

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

Provider Enumeration Date	:	09/18/2025
Last Update Date	:	09/18/2025

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Directions to “ KAITLYN ALEXIS KIMBALL ” Practice Location

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