Individual provider · Type 1 NPI

Jack McIntyre Kimmell

Student in an Organized Health Care Education/Training Program · South Bend, IN

NPI number 1740731116 Active

Practice location

1526 East Lasalle
South Bend, IN 46617

Call (574) 310-1911 Map

Mailing address

1526 E Lasalle Ave
South Bend, IN 46617-2606

Specialties and licenses

TaxonomyCodeLicense
Athletic Trainer 2255A2300X3925375607 (IN)
Student in an Organized Health Care Education/Training Program Primary 390200000X3925375607 (IN)

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1740731116

Jack McIntyre Kimmell's National Provider Identifier is 1740731116, issued on Oct 20, 2016. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in South Bend, IN. The record was last updated on Oct 20, 2016.