Provider Demographics
NPI:1295144871
Name:MCCREADY, KIMBERLY DENISE (RN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DENISE
Last Name:MCCREADY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:DENISE
Other - Last Name:BOGGESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7131 ASHBURTON DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-3712
Mailing Address - Country:US
Mailing Address - Phone:865-368-5466
Mailing Address - Fax:
Practice Address - Street 1:7131 ASHBURTON DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-3712
Practice Address - Country:US
Practice Address - Phone:865-368-5466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000103086163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse