Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 45968 | TN |
NPI | 1073721635 |
---|---|
Provider Name | Kristopher J. Kimball |
First Address | Nashville, TN 37244-0459 |
Second Address | Knoxville, TN 37920-1524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 11/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1518855 | (05) | TN |