Provider Demographics
NPI:1881147130
Name:KIMBLE, ERIN GROH (PA-C)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:GROH
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:MICHELLE
Other - Last Name:GROH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4707 PAPERMILL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1907
Mailing Address - Country:US
Mailing Address - Phone:865-602-7983
Mailing Address - Fax:865-602-7984
Practice Address - Street 1:4707 PAPERMILL DR STE 200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1907
Practice Address - Country:US
Practice Address - Phone:865-602-7983
Practice Address - Fax:865-602-7984
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7970363A00000X
TN7970363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant