Healthcare Provider Details

I. General information

NPI: 1548722168
Provider Name (Legal Business Name): FAYE MARIE KIBLER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FAYE MARIE TATA

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 PARKSIDE DR STE 209
KNOXVILLE TN
37934-1985
US

IV. Provider business mailing address

3024 BUSINESS PARK CIR
GOODLETTSVILLE TN
37072-3132
US

V. Phone/Fax

Practice location:
  • Phone: 865-251-3030
  • Fax: 865-966-0191
Mailing address:
  • Phone: 615-239-2018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number5846
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number5846
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number5846
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: