Provider Demographics
NPI:1750881348
Name:KIMBRO, KELLI ROCHELLE (LVN)
Entity type:Individual
Prefix:MS
First Name:KELLI
Middle Name:ROCHELLE
Last Name:KIMBRO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 MIDWESTERN PKWY APT 111
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-1937
Mailing Address - Country:US
Mailing Address - Phone:940-217-4251
Mailing Address - Fax:
Practice Address - Street 1:1717 MIDWESTERN PKWY APT 111
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76302-1937
Practice Address - Country:US
Practice Address - Phone:940-217-4251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX176820164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse