Sandy J. Kimmel, D.O., P.a.

Primary specialty

SpecialistTaxonomy code 174400000X

License

200400893 Issued in NC

Legal business name

SANDY J. KIMMEL, D.O., P.A.

Practice address

3400 Executive Dr
Suite 203
Raleigh, NC 27609-7476

Phone

(919) 872-0390

Fax

(919) 872-0391

NPI assigned

Mar 22, 2007

Organization subpart

Yes

Parent organization

SANDY J. KIMMEL, D.O, P.A.As reported in NPPES

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

Authorized official

Name

Mrs. Bonnie Donleycott

Title

Office Manager

Phone

(919) 872-0390

Specialties & licenses 1

Addresses

Other identifiers 2

Part of

Sandy J Kimmel DO PA

Locations

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294790400000",
    "number": "1992821482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 EXECUTIVE DR",
            "address_2": "SUITE 203",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276097476",
            "telephone_number": "919-872-0390",
            "fax_number": "919-872-0391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 EXECUTIVE DR",
            "address_2": "SUITE 203",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276097476",
            "telephone_number": "919-872-0390",
            "fax_number": "919-872-0391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDY J. KIMMEL, D.O., P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SANDY J. KIMMEL, D.O, P.A.",
        "enumeration_date": "2007-03-22",
        "last_updated": "2011-01-12",
        "status": "A",
        "authorized_official_last_name": "DONLEYCOTT",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "919-872-0390",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NC",
            "license": "200400893",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89137PC",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI NUMBER",
            "identifier": "1598714313",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Destny Anastasia Sandoval
• Erick Joel Sandoval, NP
• Sandra M. Story, Psy.D., P.C.
• Sandra Martin, D.M.D.
• John Arnold Sandru, CRNA
• Elaine Sanford-Sawyer, LCSW; LICDC
• Julian Wayne Sanford, CRNA
• Lisa Ann Sanford, MSN FNP
• Dawn Ida Sanger
• Sania Hasan PLLC

• Specialist in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2011; 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.