Provider Demographics
NPI:1437947348
Name:KIMBALL, RILEY PAUL (MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:PAUL
Last Name:KIMBALL
Suffix:
Gender:M
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5019 LYTLE ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15207-1767
Mailing Address - Country:US
Mailing Address - Phone:570-982-4781
Mailing Address - Fax:
Practice Address - Street 1:5019 LYTLE ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15207-1767
Practice Address - Country:US
Practice Address - Phone:570-982-4781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN728353163W00000X
PASP032785363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse