Provider Demographics
NPI:1619041803
Name:QUIGLEY, KIMBERLY ANNE (MEDICAL PHYSICIAN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE
Last Name:QUIGLEY
Suffix:
Gender:F
Credentials:MEDICAL PHYSICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 PERIMETER PARK RD STE A
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-2200
Mailing Address - Country:US
Mailing Address - Phone:658-288-8970
Mailing Address - Fax:865-935-8179
Practice Address - Street 1:110 PERIMETER PARK RD STE A
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-2200
Practice Address - Country:US
Practice Address - Phone:658-288-8970
Practice Address - Fax:865-935-8179
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4232372084P0800X
TNMD416312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3827073Medicaid
TN3827073Medicare ID - Type Unspecified
TN3827073Medicaid