Provider Demographics
NPI:1588628838
Name:KING, KIMBERLY N (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:N
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:D
Other - Last Name:NEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:300 STONECREST BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6832
Mailing Address - Country:US
Mailing Address - Phone:615-984-4751
Mailing Address - Fax:615-984-4752
Practice Address - Street 1:300 STONECREST BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6832
Practice Address - Country:US
Practice Address - Phone:615-984-4751
Practice Address - Fax:615-984-4752
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23970207V00000X
TN46175207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2003556OtherFIRST CHOICE
SCPC6427Medicaid
SCT81337Medicaid
SC2003556OtherFIRST CHOICE
SCT81337Medicaid