Provider Demographics
NPI:1437174356
Name:EMMETT, KIM R (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:R
Last Name:EMMETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11440 PARKSIDE DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2658
Mailing Address - Country:US
Mailing Address - Phone:865-288-1548
Mailing Address - Fax:865-377-1002
Practice Address - Street 1:11440 PARKSIDE DR
Practice Address - Street 2:SUITE 302
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2658
Practice Address - Country:US
Practice Address - Phone:865-288-1548
Practice Address - Fax:865-377-1002
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD31549174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3842128Medicare ID - Type Unspecified
TNE01411Medicare UPIN