Provider Demographics
NPI:1043427982
Name:KEEL, KIMBA J (RN)
Entity Type:Individual
Prefix:
First Name:KIMBA
Middle Name:J
Last Name:KEEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:45 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2337
Mailing Address - Country:US
Mailing Address - Phone:731-664-2082
Mailing Address - Fax:731-664-1988
Practice Address - Street 1:45 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2337
Practice Address - Country:US
Practice Address - Phone:731-664-2082
Practice Address - Fax:731-664-1988
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNRN 116453163WP0808X
TN13420363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health