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General NPI Number Information
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NPI Number | 1457544868
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Entity Type | Individual
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Provider Name | KIMBERLY D ROLLER MD
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Gender | Female
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 1242 W SHIPLEY FERRY RD
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City | KINGSPORT
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State | TN
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Zip | 37663-3323
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Country | US
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Telephone | 423-239-7300
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Fax | 423-239-7607
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Provider Business Mailing Address
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Address Line | PO BOX 632476
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City | CINCINNATI
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State | OH
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Zip | 45263-2476
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Country | US
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Telephone | 423-239-7300
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Fax | 423-239-7607
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101244717
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 50121
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License Number State | TN
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