Healthcare Provider Details

I. General information

NPI: 1619619707
Provider Name (Legal Business Name): KIM RENEE STRANGE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2022
Last Update Date: 04/10/2022
Certification Date: 04/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2939 ESSARY DR STE 2
KNOXVILLE TN
37918-2464
US

IV. Provider business mailing address

7822 CODY LN
KNOXVILLE TN
37938-3166
US

V. Phone/Fax

Practice location:
  • Phone: 865-687-1886
  • Fax:
Mailing address:
  • Phone: 865-719-2694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH4755
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: