Provider Demographics
NPI:1568466399
Name:STURGILL, KIMBERLY (FNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:STURGILL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:423-857-2070
Practice Address - Street 1:240 MEDICAL PARK BLVD
Practice Address - Street 2:STE 3000
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7352
Practice Address - Country:US
Practice Address - Phone:423-990-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024157548363LF0000X
TNAPN 6687363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3901076Medicaid
VA007785569Medicaid
0281780003Medicare PIN
VA006699H81Medicare ID - Type Unspecified
TNCA5023Medicare PIN
S74973Medicare UPIN
TN103I086169Medicare UPIN
TN500005089Medicare PIN
TN3901076Medicare ID - Type Unspecified
VA006699H81Medicare PIN
TN3700592Medicare UPIN
VAC06181Medicare PIN
0281780001Medicare PIN