Provider Demographics
NPI:1346426822
Name:KIMBERLY M ROHALEY MD LLC
Entity Type:Organization
Organization Name:KIMBERLY M ROHALEY MD LLC
Other - Org Name:KIDS CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROHALEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-207-8397
Mailing Address - Street 1:202 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-4566
Mailing Address - Country:US
Mailing Address - Phone:931-207-8397
Mailing Address - Fax:931-207-8394
Practice Address - Street 1:202 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4566
Practice Address - Country:US
Practice Address - Phone:931-207-8397
Practice Address - Fax:931-207-8394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43204208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPENDINGMedicaid
TNG29314Medicare UPIN