Provider Demographics
NPI:1225020563
Name:SCOTT, KIM PUCKETT (MD)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:PUCKETT
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:PUCKETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5833 AEDC RD
Mailing Address - Street 2:
Mailing Address - City:ESTILL SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37330-3915
Mailing Address - Country:US
Mailing Address - Phone:931-392-4169
Mailing Address - Fax:931-392-4187
Practice Address - Street 1:1041 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2450
Practice Address - Country:US
Practice Address - Phone:615-617-3499
Practice Address - Fax:615-617-3627
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 031459207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG079880281OtherMEDICARE
TN3840636Medicaid
TN3840636Medicare ID - Type Unspecified