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General NPI Number Information
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NPI Number | 1679166243
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Entity Type | Individual
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Provider Name | DEBORAH ESTER KIBWAGE NP-C
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Gender | Female
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Dates
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Enumeration Date | 02/15/2021
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Last Update Date | 02/25/2021
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Provider Practice Location Address
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Address Line | 1508 TOMBRAS AVE
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City | CHATTANOOGA
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State | TN
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Zip | 37412-2720
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Country | US
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Telephone | 423-867-4969
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Fax |
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Provider Business Mailing Address
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Address Line | 111 DURKEE RD NE STE 49
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City | CLEVELAND
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State | TN
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Zip | 37323-6401
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Country | US
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Telephone | 865-443-5514
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Fax |
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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 | 28929
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License Number State | TN
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