Provider Demographics
NPI:1457408833
Name:KIRKPATRICK, KIMBERLY S (DPH)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-0850
Mailing Address - Country:US
Mailing Address - Phone:423-272-3214
Mailing Address - Fax:423-272-8706
Practice Address - Street 1:4966 HIGHWAY 11W
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-6028
Practice Address - Country:US
Practice Address - Phone:423-272-3214
Practice Address - Fax:423-272-8706
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist