Provider Demographics
NPI:1700092277
Name:KIMBALL, RITA (NP-P)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:NP-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 ROUTE 9
Mailing Address - Street 2:SUITE 7B
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-4993
Mailing Address - Country:US
Mailing Address - Phone:845-705-4804
Mailing Address - Fax:845-632-2940
Practice Address - Street 1:1285 ROUTE 9 STE 7B
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-4993
Practice Address - Country:US
Practice Address - Phone:845-705-4804
Practice Address - Fax:419-273-0495
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400323363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF400323OtherNP LICENSE
NY02264859Medicaid
NY02264859Medicaid