Provider Demographics
NPI:1750594925
Name:BOLTON, KIMBERLY SUE (PHD, WHCNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUE
Last Name:BOLTON
Suffix:
Gender:F
Credentials:PHD, WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9616 NORRIS FWY
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-2303
Mailing Address - Country:US
Mailing Address - Phone:865-925-2615
Mailing Address - Fax:
Practice Address - Street 1:939 E EMERALD AVE
Practice Address - Street 2:SUITE 801
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-4540
Practice Address - Country:US
Practice Address - Phone:865-546-6721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000006278374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel