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General NPI Number Information
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NPI Number | 1649263419
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Entity Type | Individual
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Provider Name | KIMBERLY ANN DYMOND PAC
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Gender | Female
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 988 OAK RIDGE TPKE STE 200
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City | OAK RIDGE
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State | TN
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Zip | 37830-6919
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Country | US
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Telephone | 865-483-4366
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Fax | 615-867-8073
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Provider Business Mailing Address
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Address Line | 988 OAK RIDGE TPKE STE 200
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City | OAK RIDGE
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State | TN
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Zip | 37830-6919
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Country | US
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Telephone | 865-483-4366
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Fax | 615-867-8073
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1248
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License Number State | TN
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