Kimbrough, Felicia Desha

Kimbrough, Felicia Desha is an individual health care provider with primary practice located at 1301 E Walnut St Rm J120 , Carbondale IL 62901-5004. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Kimbrough, Felicia Desha can be contacted via phone (618) 519-9200.

Contact Information

Primary practice address
1301 E Walnut St Rm J120 Carbondale IL 62901-5004
Phone: (618) 519-9200
Fax: (618) 457-8931
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 209007991 Illinois

Profile Details

NPI number 1679740708
LBN Legal business name Kimbrough, Felicia Desha
Credentials FNP BC
Entity Individual
Sole proprietor 1 No
Enumeration date May 8th, 2008
Last updated Aug 16th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679740708 NPPES
Illinois MEDICAID 406333266001
Illinois MEDICAID 370966854002
Illinois MEDICAID 370966854005
Illinois Other CF3444

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