Healthcare Provider Details

I. General information

NPI: 1356745848
Provider Name (Legal Business Name): KIMBERLY GEAN REDFEARN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2014
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13851 HIGHWAY 28
WHITWELL TN
37397-5373
US

IV. Provider business mailing address

432 FAMILY RD
DUNLAP TN
37327-6545
US

V. Phone/Fax

Practice location:
  • Phone: 423-658-9200
  • Fax: 423-658-2195
Mailing address:
  • Phone: 423-949-6637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19223
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: