Provider Demographics
NPI:1427321942
Name:QUALLS, KIMBERLY H (NP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:H
Last Name:QUALLS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7551 DANNAHER DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-4029
Mailing Address - Country:US
Mailing Address - Phone:865-859-7420
Mailing Address - Fax:865-859-7429
Practice Address - Street 1:7551 DANNAHER DR
Practice Address - Street 2:SUITE 140
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-4029
Practice Address - Country:US
Practice Address - Phone:865-859-7420
Practice Address - Fax:865-859-7429
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN16517363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1527686Medicaid
TN1527686Medicaid