Provider Demographics
NPI:1972600393
Name:ADKINS, KIMBERLY CRUMBLEY (PA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:CRUMBLEY
Last Name:ADKINS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:RENEE
Other - Last Name:CRUMBLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:975 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2173
Mailing Address - Country:US
Mailing Address - Phone:423-778-7000
Mailing Address - Fax:
Practice Address - Street 1:975 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2173
Practice Address - Country:US
Practice Address - Phone:423-778-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAP1949363A00000X
VA0110001947363A00000X
LAPA.200347363A00000X
TN4808363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04700372Medicaid
LA2115618Medicaid
VA130765ZAKBMedicare PIN
LA2115618Medicaid
LA57061PD31Medicare PIN