Provider Demographics
NPI:1457752438
Name:POTEET, KIMBERLY DETHERO (RN, BSN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DETHERO
Last Name:POTEET
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 DOOLEY ST SE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-6220
Mailing Address - Country:US
Mailing Address - Phone:423-728-7020
Mailing Address - Fax:423-479-6130
Practice Address - Street 1:201 DOOLEY ST SE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-6220
Practice Address - Country:US
Practice Address - Phone:423-428-7020
Practice Address - Fax:423-479-6130
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000104789163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health