Healthcare Provider Details

I. General information

NPI: 1174419527
Provider Name (Legal Business Name): KEVIN KINGERY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2025
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 19TH ST
KNOXVILLE TN
37916-1854
US

IV. Provider business mailing address

735 BOONE DR
SEYMOUR TN
37865-5194
US

V. Phone/Fax

Practice location:
  • Phone: 865-331-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number238807
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: