Individual
KIMBERLY ANN RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
300 LABORATORY RD, OAK RIDGE, TN 37830
(865) 482-7698
Mailing address
2717 EAST OAKLAND AVENUE, JOHNSON CITY, TN 37601-1843
(423) 926-2358
(423) 926-2680
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
36903
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3885411
—
TN
01
—
P00040818
RR MEDICARE PIN
TN
Enumeration date
06/28/2006
Last updated
01/10/2024
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