Provider Demographics
NPI:1477334134
Name:OWENS, KIMBERLY (FNP-C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 W ELK AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2654
Mailing Address - Country:US
Mailing Address - Phone:423-543-2584
Mailing Address - Fax:423-722-2060
Practice Address - Street 1:1500 W ELK AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2654
Practice Address - Country:US
Practice Address - Phone:423-543-2584
Practice Address - Fax:423-722-2060
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34806363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner