Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | APN0000011042 | TN |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | APN0000011042 | TN |
NPI | 1336262534 |
---|---|
Provider Name | Mrs. Kimberly Dodd Barnes |
First Address | Chattanooga, TN 37403-2103 |
Second Address | Chattanooga, TN 37403-2103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 21/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
650913387 | TAX ID (01) | TN |