Healthcare Provider Details

I. General information

NPI: 1275287468
Provider Name (Legal Business Name): KIMBERLY ARNOLD RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 02/07/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 COPPER HILL DR
JOHNSON CITY TN
37601-3061
US

IV. Provider business mailing address

205 COPPER HILL DR
JOHNSON CITY TN
37601-3061
US

V. Phone/Fax

Practice location:
  • Phone: 614-832-3622
  • Fax:
Mailing address:
  • Phone: 614-832-3622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number8291
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: