Jim R Kimbal, ATC, LAT, LMT, CSCS

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

124560 Issued in AK

Practice address

1650 Cowles Street
FMH Rehab Department
Fairbanks, AK 99701

Phone

(907) 458-5670

NPI assigned

May 4, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601251200000",
    "number": "1114985322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 74293",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997074293",
            "telephone_number": "907-479-2526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 COWLES STREET",
            "address_2": "FMH REHAB DEPARTMENT",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "99701",
            "telephone_number": "907-458-5670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBAL",
        "first_name": "JIM",
        "middle_name": "R",
        "credential": "ATC, LAT, LMT, CSCS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2020-09-28",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "UT",
            "license": "10650493-4810",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "IL",
            "license": "227005348",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "AK",
            "license": "117476",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "AK",
            "license": "124560",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Paul Kilgore, PA-C
• Mary Killian, RN
• Brian Killion
• Jason Kim
• Sam Y Kim, M.D.
• Kimberly J Wonderlich MD Faad Dermatology LLC
• Heidie Kimmel
• Claire Joann Kindschi, OTD
• Kathryn L Kindt, ADVANCED NURSE PRACT
• King Cab Inc

• Athletic Trainer in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Athletic Trainer in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.