Healthcare Provider Details

I. General information

NPI: 1841419355
Provider Name (Legal Business Name): MS. KIMBERLY MICHELLE ROLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 WESTERN AVE
KNOXVILLE TN
37921-5718
US

IV. Provider business mailing address

4423 BONNYWOOD WAY
KNOXVILLE TN
37912-4451
US

V. Phone/Fax

Practice location:
  • Phone: 865-934-6786
  • Fax: 865-934-6775
Mailing address:
  • Phone: 865-934-6786
  • Fax: 865-934-6775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0000013689
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: