Provider Demographics
NPI:1073666335
Name:GRANDE, KIMBERLY K (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:GRANDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10215 KINGSTON PIKE # 200
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3222
Mailing Address - Country:US
Mailing Address - Phone:865-584-8580
Mailing Address - Fax:865-251-9939
Practice Address - Street 1:10215 KINGSTON PIKE # 200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3222
Practice Address - Country:US
Practice Address - Phone:865-584-8580
Practice Address - Fax:865-251-9939
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD34636174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3858404Medicare ID - Type Unspecified
G82706Medicare UPIN