MEDICARE: KIMBERLY SUE BOLTON PHD, WHCNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374T00000X	Religious Nonmedical Nursing Personnel	APN0000006278	TN

General Provider Information

NPI Number	:	1750594925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY SUE BOLTON PHD, WHCNP

Provider Business Mailing Address
First Line	:	9616 NORRIS FWY
Second Line	:
City	:	POWELL
State	:	TN
Zip	:	37849-2303
Country	:	US
Telephone Number	:	865-925-2615
Fax Number	:

Provider Business Practice Location Address
First Line	:	939 E EMERALD AVE
Second Line	:	SUITE 801
City	:	KNOXVILLE
State	:	TN
Zip	:	37917-4540
Country	:	US
Telephone Number	:	865-546-6721
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	09/26/2008

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