Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 30497 | TN |
NPI | 1043291370 |
---|---|
Provider Name | Kimberly C Bergeron |
First Address | Nashville, TN 37203-1852 |
Second Address | Brentwood, TN 37027-8019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 21/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G98621 | (02) | TN |
Q034664 | (05) | TN |