Healthcare Provider Details

I. General information

NPI: 1679166243
Provider Name (Legal Business Name): DEBORAH ESTER KIBWAGE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 TOMBRAS AVE
CHATTANOOGA TN
37412-2720
US

IV. Provider business mailing address

111 DURKEE RD NE STE 49
CLEVELAND TN
37323-6401
US

V. Phone/Fax

Practice location:
  • Phone: 423-867-4969
  • Fax:
Mailing address:
  • Phone: 865-443-5514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28929
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: