Bradley Johnson Kimble, MED, ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT.002460 Issued in OH

Practice address

6100 Main St # Ms 552
Houston, TX 77005-1827

Phone

(713) 348-6363

Fax

(713) 348-5622

NPI assigned

Jan 8, 2007

Last updated

Mar 6, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Baldwin Wallace University

  • Student Health Clinic/Center
  • Berea, OH
  • NPI 1730157272
  NPD (past)

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583452800000",
    "number": "1427106111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "RICE UNIVERSITY",
            "address_2": "6100 MAIN STREET, MS 552",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77005",
            "telephone_number": "713-348-4738",
            "fax_number": "713-348-5622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6100 MAIN ST # MS 552",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770051827",
            "telephone_number": "713-348-6363",
            "fax_number": "713-348-5622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBLE",
        "first_name": "BRADLEY",
        "middle_name": "JOHNSON",
        "credential": "MED, ATC, LAT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-08",
        "last_updated": "2020-03-06",
        "certification_date": "2020-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "OH",
            "license": "AT.002460",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly T Richter
• Kimberly Williams-Watson, MD
• Jennifer Diane Kimberly, MA-CCC-A
• Deirdre Kimble-Carter
• Barbara Smith Kimble
• Khelicity Kimble
• Danielle Kimbrough
• Lane K Kimbrough, LO
• Richard L. Kimbrough, M.D.
• Storm Nicole Kimbrow, DDS

• Athletic Trainer in Houston, TX
• Providers in Houston, TX by specialty
• Athletic Trainer in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 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.