MEDICARE: KHRISTAN DEICHERT CIMINO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	9872	TN
2	1041C0700X	Clinical Social Worker	259675	KY

General Provider Information

NPI Number	:	1073266656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHRISTAN DEICHERT CIMINO

Provider Business Mailing Address
First Line	:	9129 CROSS PARK DR STE 100
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-4505
Country	:	US
Telephone Number	:	865-983-2899
Fax Number	:	865-409-5948

Provider Business Practice Location Address
First Line	:	9129 CROSS PARK DR STE 100
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-4505
Country	:	US
Telephone Number	:	865-983-2899
Fax Number	:	865-409-5948

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2022
Last Update Date	:	12/16/2025

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Directions to “ KHRISTAN DEICHERT CIMINO ” Practice Location

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