Kimberly S Bacon, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

15209 Issued in TN

Practice address

408 N State of Franklin Rd
Suite 24
Johnson City, TN 37604-6089

Phone

(423) 431-1810

Fax

(423) 431-1811

NPI assigned

Jan 5, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Renuven Health Partners of Georgia PC

  • Internal Medicine Physician
  • Fort Oglethorpe, GA
  • NPI 1871196519
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1325721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485388800000",
    "number": "1215207451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 N STATE OF FRANKLIN RD",
            "address_2": "SUITE 24",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046089",
            "telephone_number": "423-431-1810",
            "fax_number": "423-431-1811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 N STATE OF FRANKLIN RD",
            "address_2": "SUITE 24",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046089",
            "telephone_number": "423-431-1810",
            "fax_number": "423-431-1811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACON",
        "first_name": "KIMBERLY",
        "middle_name": "S",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-01-05",
        "last_updated": "2017-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "15209",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215207451",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1527812",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100195690",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "P01200424",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100195690",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Back to Health P.C.
• James Steven Backers, PHARM D
• Joanne E Backofen, M.D.
• Casey E. Bacon, M.S. CCC-SLP
• Charla Barefield Bacon, FNP-C
• Paul Ryan Bader, PA
• Kristina Bagley
• Mona Mylene Baharestani, PHD, APN, CWOCN, CWS
• Anne Bailey, R.P.H
• Brittany Ann Bailey, RN, SRNA

• All providers in Johnson City, TN
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.