MEDICARE: KIMBERLY WEBB LLC

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	261QP2300X	Primary Care Clinic/Center	19686	TN

General Provider Information

NPI Number	:	1538552443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIMBERLY WEBB LLC

Provider Business Mailing Address
First Line	:	1303 RIGGS CHAPEL RD
Second Line	:
City	:	HARRIMAN
State	:	TN
Zip	:	37748-7364
Country	:	US
Telephone Number	:	865-755-2496
Fax Number	:

Provider Business Practice Location Address
First Line	:	1303 RIGGS CHAPEL RD
Second Line	:
City	:	HARRIMAN
State	:	TN
Zip	:	37748-7364
Country	:	US
Telephone Number	:	865-755-2496
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER--FNP
Name	:	KIMBERLY ELAINE WEBB
Credential	:	FNP
Telephone Number	:	865-755-2496

Provider Enumeration Date	:	03/17/2015
Last Update Date	:	03/17/2015

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