Provider Demographics
NPI:1033584461
Name:CAMPBELL, KIMBERLY (ARNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 N CHARLES G SEIVERS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-6738
Mailing Address - Country:US
Mailing Address - Phone:865-647-3200
Mailing Address - Fax:865-463-3672
Practice Address - Street 1:2200 N CHARLES G SEIVERS BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-6738
Practice Address - Country:US
Practice Address - Phone:865-647-3200
Practice Address - Fax:865-463-3672
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8177363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MC3686447OtherDEA