Provider Demographics
NPI:1649263419
Name:DYMOND, KIMBERLY ANN (PAC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:DYMOND
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988 OAK RIDGE TPKE STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6919
Mailing Address - Country:US
Mailing Address - Phone:865-483-4366
Mailing Address - Fax:615-867-8073
Practice Address - Street 1:988 OAK RIDGE TPKE STE 200
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6919
Practice Address - Country:US
Practice Address - Phone:865-483-4366
Practice Address - Fax:615-867-8073
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1248363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN36634311Medicaid
TN1522133Medicaid
TN3730229Medicaid
TN36634311Medicaid
TN3730229Medicaid