Healthcare Provider Details

I. General information

NPI: 1982414561
Provider Name (Legal Business Name): KEVIN REIMER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 MCCALLIE AVE
CHATTANOOGA TN
37403-2598
US

IV. Provider business mailing address

5700 KNOTTY PINE DR
OOLTEWAH TN
37363-8360
US

V. Phone/Fax

Practice location:
  • Phone: 423-425-4644
  • Fax:
Mailing address:
  • Phone: 423-494-3465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number212752
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: