Provider Demographics
NPI:1336262534
Name:BARNES, KIMBERLY DODD (CNNP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DODD
Last Name:BARNES
Suffix:
Gender:F
Credentials:CNNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 E 3RD ST # 159
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2103
Mailing Address - Country:US
Mailing Address - Phone:423-778-6170
Mailing Address - Fax:423-778-6938
Practice Address - Street 1:975 E 3RD ST
Practice Address - Street 2:BX 159
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2103
Practice Address - Country:US
Practice Address - Phone:423-778-6170
Practice Address - Fax:423-778-6938
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000011042363LN0005X, 363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN650913387OtherTAX ID