Healthcare Provider Details

I. General information

NPI: 1457553802
Provider Name (Legal Business Name): KIMBERLY ANN KEETON DPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10703 DUTCHTOWN RD
KNOXVILLE TN
37932-3208
US

IV. Provider business mailing address

11825 YARNELL RD
KNOXVILLE TN
37932-2340
US

V. Phone/Fax

Practice location:
  • Phone: 865-966-7496
  • Fax:
Mailing address:
  • Phone: 865-218-6122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9434
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: