Provider Demographics
NPI:1275809816
Name:HYDER, KIMBERLY DEVAULT (RN, PTA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DEVAULT
Last Name:HYDER
Suffix:
Gender:F
Credentials:RN, PTA
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:DEVAULT
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, PTA
Mailing Address - Street 1:1865 SEVEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-1475
Mailing Address - Country:US
Mailing Address - Phone:423-736-7120
Mailing Address - Fax:
Practice Address - Street 1:6600 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:BUILDING 400, SUITE 125
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-6773
Practice Address - Country:US
Practice Address - Phone:866-587-9922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000128312163W00000X
TNPTA0000004769225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No163W00000XNursing Service ProvidersRegistered Nurse