Healthcare Provider Details

I. General information

NPI: 1750594925
Provider Name (Legal Business Name): KIMBERLY SUE BOLTON PHD, WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 E EMERALD AVE SUITE 801
KNOXVILLE TN
37917-4540
US

IV. Provider business mailing address

9616 NORRIS FWY
POWELL TN
37849-2303
US

V. Phone/Fax

Practice location:
  • Phone: 865-546-6721
  • Fax:
Mailing address:
  • Phone: 865-925-2615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License NumberAPN0000006278
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: