Provider Demographics
NPI:1700064904
Name:LILLEY, KIMBERLY DAWN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DAWN
Last Name:LILLEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:DAWN
Other - Last Name:GREEN, YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN-RN, FNP-C
Mailing Address - Street 1:1018 CHASE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-1402
Mailing Address - Country:US
Mailing Address - Phone:423-282-3379
Mailing Address - Fax:423-430-6227
Practice Address - Street 1:1018 CHASE DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-1402
Practice Address - Country:US
Practice Address - Phone:423-282-3379
Practice Address - Fax:423-430-6227
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000024453363LF0000X
TNRN0000161066163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse