Kimberly Dawn Holtsclaw, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

24568 Issued in TN

Practice address

1826 N Main Ave
Erwin, TN 37650-8932

Phone

(423) 743-6135

Fax

(423) 743-0035

NPI assigned

Aug 13, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1534118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562889600000",
    "number": "1437638129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 850",
            "city": "ROGERSVILLE",
            "state": "TN",
            "postal_code": "378570850",
            "telephone_number": "423-272-9163",
            "fax_number": "423-921-6920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1826 N MAIN AVE",
            "city": "ERWIN",
            "state": "TN",
            "postal_code": "376508932",
            "telephone_number": "423-743-6135",
            "fax_number": "423-743-0035"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "152 Highway 143",
            "address_purpose": "LOCATION",
            "city": "Roan Mountain",
            "state": "TN",
            "postal_code": "376873002",
            "country_code": "US",
            "telephone_number": "423-772-3276",
            "fax_number": "423-772-4816",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLTSCLAW",
        "first_name": "KIMBERLY",
        "middle_name": "DAWN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-13",
        "last_updated": "2019-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "24568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Erwin, TN
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.