Healthcare Provider Details

I. General information

NPI: 1821220062
Provider Name (Legal Business Name): KIMBERLY M GLOW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2009
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 AGNES RD STE 200
KNOXVILLE TN
37919-6306
US

IV. Provider business mailing address

116 AGNES RD STE 200
KNOXVILLE TN
37919-6306
US

V. Phone/Fax

Practice location:
  • Phone: 865-229-6575
  • Fax: 217-215-9876
Mailing address:
  • Phone: 217-369-7878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDR.0062432
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number036102300
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number68798
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: