Provider Demographics
NPI:1467801472
Name:CARTER, KIMBERLY (RN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5858 WOLF CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SPRING CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37381-4837
Mailing Address - Country:US
Mailing Address - Phone:423-490-5171
Mailing Address - Fax:
Practice Address - Street 1:350 DAWSON ST
Practice Address - Street 2:STE. B
Practice Address - City:VONORE
Practice Address - State:TN
Practice Address - Zip Code:37885-2420
Practice Address - Country:US
Practice Address - Phone:423-884-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN100609163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse