Provider Demographics
NPI:1184793911
Name:PAYNE, KIMBERLY C
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:C
Last Name:PAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10321 CASTLEBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-7218
Mailing Address - Country:US
Mailing Address - Phone:865-777-0119
Mailing Address - Fax:
Practice Address - Street 1:501 ADESSA PKWY STE A150
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37771-6719
Practice Address - Country:US
Practice Address - Phone:865-986-4530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist