Provider Demographics
NPI:1962979617
Name:KLEINE, KIMBERLY KAY (MSN, ARPN, FNP-C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAY
Last Name:KLEINE
Suffix:
Gender:F
Credentials:MSN, ARPN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KELLOGG DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37683-4077
Mailing Address - Country:US
Mailing Address - Phone:423-460-3232
Mailing Address - Fax:423-460-3234
Practice Address - Street 1:100 KELLOGG DRIVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN CITY
Practice Address - State:TN
Practice Address - Zip Code:37683-4077
Practice Address - Country:US
Practice Address - Phone:423-460-3232
Practice Address - Fax:423-460-3234
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2024-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25110363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1962979617OtherINDIVIDUAL NPI
TN1548886385OtherNORTHEAST TENNESSEE HEALTH AND HOME CARE PLLC NPI
TN25110OtherTN LICENSE