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General NPI Number Information
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NPI Number | 1619251626
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Entity Type | Individual
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Provider Name | KIMBERLY C NICHOLS NP
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Gender | Female
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 01/10/2013
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Provider Practice Location Address
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Address Line | 1 MEDICAL PARK BLVD
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City | BRISTOL
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State | TN
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Zip | 37620-7430
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Country | US
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Telephone | 423-844-5583
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Fax | 423-844-5588
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Provider Business Mailing Address
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Address Line | 999 EXECUTIVE PARK BLVD SUITE 201
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City | KINGSPORT
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State | TN
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Zip | 37660-4632
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Country | US
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Telephone | 423-224-3250
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Fax | 423-224-3258
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024169691
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 16361
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License Number State | TN
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