Provider Demographics
NPI:1033192653
Name:KIMERY, TERESA M (CRNA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:KIMERY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 BARREN VALLEY RD.
Mailing Address - Street 2:
Mailing Address - City:CHUCKEY
Mailing Address - State:TN
Mailing Address - Zip Code:37641
Mailing Address - Country:US
Mailing Address - Phone:423-552-0583
Mailing Address - Fax:423-257-3724
Practice Address - Street 1:509 BARREN VALLEY RD.
Practice Address - Street 2:
Practice Address - City:CHUCKEY
Practice Address - State:TN
Practice Address - Zip Code:37641
Practice Address - Country:US
Practice Address - Phone:423-552-0583
Practice Address - Fax:423-257-3724
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC920367500000X
TNAPN0000010840367500000X
NC45264367500000X
KY3810A367500000X
KY1099398163W00000X
TNRN0000060800163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse