Provider Demographics
NPI:1679743140
Name:KIMSEY, ERIC D (BOCP/L)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:D
Last Name:KIMSEY
Suffix:
Gender:M
Credentials:BOCP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 WILLOW CIR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-6854
Mailing Address - Country:US
Mailing Address - Phone:931-552-5898
Mailing Address - Fax:
Practice Address - Street 1:1823 CHARLOTTE AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2104
Practice Address - Country:US
Practice Address - Phone:615-340-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier