Provider Demographics
NPI:1902857816
Name:KEINATH, KIM (PHD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:KEINATH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 W MORRIS BLVD
Mailing Address - Street 2:STE G HEALTHSTAR PHYSICIANS
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813
Mailing Address - Country:US
Mailing Address - Phone:423-318-0014
Mailing Address - Fax:423-318-2595
Practice Address - Street 1:1907 W MORRIS BLVD
Practice Address - Street 2:STE G HEALTHSTAR PHYSICIANS
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813
Practice Address - Country:US
Practice Address - Phone:423-318-0014
Practice Address - Fax:423-318-2595
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1911103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1506038Medicaid
TN3687172Medicaid
TN3707881Medicare PIN
TN1506038Medicaid
TN3980158Medicare PIN
TN3687173Medicare PIN
S13618Medicare UPIN