Provider Demographics
NPI:1821220062
Name:GLOW, KIMBERLY M (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:GLOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 AGNES RD STE 200
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-6306
Mailing Address - Country:US
Mailing Address - Phone:217-369-7878
Mailing Address - Fax:
Practice Address - Street 1:116 AGNES RD STE 200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-6306
Practice Address - Country:US
Practice Address - Phone:865-229-6575
Practice Address - Fax:217-215-9876
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0062432208D00000X
IL036102300405300000X
TN68798261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty