Provider Demographics
NPI:1942099973
Name:KIMBLE LACTATION SUPPORT
Entity type:Organization
Organization Name:KIMBLE LACTATION SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN IBCLC
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN IBCLC
Authorized Official - Phone:570-647-5819
Mailing Address - Street 1:744 CARLEY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-7930
Mailing Address - Country:US
Mailing Address - Phone:570-647-5819
Mailing Address - Fax:
Practice Address - Street 1:744 CARLEY BROOK RD
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-7930
Practice Address - Country:US
Practice Address - Phone:570-647-5819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-05
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty