Provider Demographics
NPI:1508998246
Name:KIMBALL, CATHY (NP)
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CHELSEA CIR
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-6885
Mailing Address - Country:US
Mailing Address - Phone:865-986-8916
Mailing Address - Fax:
Practice Address - Street 1:9724 KINGSTON PIKE STE 1005
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-6906
Practice Address - Country:US
Practice Address - Phone:865-765-0835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005473363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics