Kellyn Gimbel, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-10583 Issued in NC

Practice address

1132 N Church St Ste 101
Greensboro, NC 27401-1040

Phone

(336) 398-3988

NPI assigned

Jan 25, 2021

Last updated

Jan 25, 2021By the provider in NPPES

Sex

Female

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

Enrolled in NC

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 1

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

• Jubilee Integrated Wellness PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Hillsborough, NC
  • NPI 1184499881
  Medicare reassignment NPD

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

{
    "created_epoch": "1611532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611532800000",
    "number": "1700476652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4705 STAFFORD DR",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277052215",
            "telephone_number": "570-778-1767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1132 N CHURCH ST STE 101",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274011040",
            "telephone_number": "336-398-3988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIMBEL",
        "first_name": "KELLYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-25",
        "last_updated": "2021-01-25",
        "certification_date": "2021-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-10583",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Toriano Jaron Gilliam
• Samantha Nabors Gilliatt
• Sydney Erin Gillispie
• Kellee Gilmore
• Patricia Diane Gilmour, MAED LMFT LPC
• William Gingher
• Ronald A Gioffre, MD
• Deborah Ellen Gipple, PH.D.
• David W Girod, M.DIV.
• Gina Michelle Girth, M.S. CCC-SLP

• Physician Assistant in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.