Individual
KIMBERLY A NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6473 KINGSTON PIKE STE 6473, KNOXVILLE, TN 37919-4832
(865) 269-6915
Mailing address
PO BOX 207830, DALLAS, TX 75320-7830
(888) 412-2649
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
778
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q005209
—
TN
Enumeration date
08/01/2006
Last updated
05/22/2024
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