Individual
JIMMY CLARKE KIMBALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
13576
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6165200
BLUE CROSS BLUE SHIELD PROVIDER ID
TN
05
—
Q007841
—
TN
Enumeration date
09/07/2006
Last updated
10/13/2020
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