Nicole Kimball, PA-C, CAQ-OBGYN

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA59084 Issued in CA

Practice address

242 Hospital Dr Ste a
Ukiah, CA 95482-4556

Phone

(707) 462-4303

NPI assigned

Oct 25, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in VT, NH, ME, CA4 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 4

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Planned Parenthood of Northern New England, IncGroup PAC ID 8729069505, 41 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Planned Parenthood of Northern New England, Inc

  dba Planned Parenthood

  • Obstetrics & Gynecology Physician
  • Colchester, VT
  • NPI 1578529350

  ME, NH

  Medicare reassignment Care Compare group
• Planned Parenthood Shasta Diablo Inc

  • Community Health Clinic/Center
  • Concord, CA
  • NPI 1982763090
  Medicare reassignment
• Planned Parenthood Shasta Diablo Inc

  dba Planned Parenthood Northern California

  • Clinical Medical Laboratory
  • San Rafael, CA
  • NPI 1750435244
  NPD (past)
• Planned Parenthood of Northern New England

  • Non-Pharmacy Dispensing Site
  • Portland, ME
  • NPI 1467843946
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1571961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785196800000",
    "number": "1083257786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2185 PACHECO ST",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945202309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "242 HOSPITAL DR STE A",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954824556",
            "telephone_number": "707-462-4303"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14671 Olympic Dr",
            "address_purpose": "LOCATION",
            "city": "Clearlake",
            "state": "CA",
            "postal_code": "954229516",
            "country_code": "US",
            "telephone_number": "707-995-2261",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIMBALL",
        "first_name": "NICOLE",
        "credential": "PA-C, CAQ-OBGYN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-25",
        "last_updated": "2026-07-28",
        "certification_date": "2026-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VT",
            "license": "055.0031689",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA59084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6714044",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VT STATE LICENSE - PA",
            "identifier": "055.0031689",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas Killebrew
• Jiyoung Kim, R.PH.
• Sang Min Kim
• Valerie Kim
• Crystal Noel Kimball, FNP, RN
• Joseph R Kimbro, MD
• Michelle L King
• Chandra Kingston
• Joy Carla Kinion
• Scott E Kinney, D. C.

• Physician Assistant in Ukiah, CA
• Providers in Ukiah, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.