Provider Demographics
NPI:1356745848
Name:REDFEARN, KIMBERLY GEAN (NP-C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:GEAN
Last Name:REDFEARN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 FAMILY RD
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:TN
Mailing Address - Zip Code:37327-6545
Mailing Address - Country:US
Mailing Address - Phone:423-949-6637
Mailing Address - Fax:
Practice Address - Street 1:13851 HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:WHITWELL
Practice Address - State:TN
Practice Address - Zip Code:37397-5373
Practice Address - Country:US
Practice Address - Phone:423-658-9200
Practice Address - Fax:423-658-2195
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19223363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily