Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | APN0000024912 | TN |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | APN0000024912 | TN |
NPI | 1336635754 |
---|---|
Provider Name | Mr. Peter Odell Kimbrell |
First Address | Brentwood, TN 37027-4692 |
Second Address | Nashville, TN 37203-1538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2018 |
Last Update Date | 27/01/2022 |