Active NPI
Jessica Kimball, DO
- Family Medicine Physician
- Pontiac, MI
National Provider Identifier
1679729107
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 5101017907
- Practice address
- 50 N Perry St
Pontiac, MI 48342-2217 - Phone
- (248) 338-5392
- Fax
- (248) 338-5567
- NPI assigned
- Aug 15, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 5101017907 | MI | Primary |
Addresses
Primary practice location
50 N Perry St
Pontiac, MI 48342-2217
Mailing address
50 N Perry St
Pontiac, MI 48342-2217
Phone (248) 338-5392
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1218758400000",
"number": "1679729107",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 N PERRY ST",
"city": "PONTIAC",
"state": "MI",
"postal_code": "483422217",
"telephone_number": "248-338-5392",
"fax_number": "248-338-5567"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 N PERRY ST",
"city": "PONTIAC",
"state": "MI",
"postal_code": "483422217",
"telephone_number": "248-338-5392",
"fax_number": "248-338-5567"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMBALL",
"first_name": "JESSICA",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-08-15",
"last_updated": "2008-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "5101017907",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pontiac, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.