Active NPI
Kimberly Griffin Hicks, M.D.
- Pediatrics Physician
- Lenoir City, TN
National Provider Identifier
1467480327
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD34033
- Practice address
- 460 Medical Park Dr
Suite 108
Lenoir City, TN 37772-5782 - Phone
- (865) 271-9536
- Fax
- (865) 986-0212
- NPI assigned
- Jun 29, 2006
- Last updated
- Dec 3, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD34033 | TN | Primary |
| Pediatric Emergency Medicine (Pediatrics) Physician | 2080P0204X | MD34033 | TN |
Addresses
Primary practice location
460 Medical Park Dr
Suite 108
Lenoir City, TN 37772-5782
Mailing address
460 Medical Park Dr
Suite 108
Lenoir City, TN 37772-5782
Phone (865) 271-9536
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1516025 | Medicaid | TN | |
| 64054729 | Medicaid | KY | |
| 3496552 | Medicaid | TN | |
| 4034474 | Other | TN | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD34033 | TN | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354492800000",
"number": "1467480327",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "460 MEDICAL PARK DR",
"address_2": "SUITE 108",
"city": "LENOIR CITY",
"state": "TN",
"postal_code": "377725782",
"telephone_number": "865-271-9536",
"fax_number": "865-986-0212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "460 MEDICAL PARK DR",
"address_2": "SUITE 108",
"city": "LENOIR CITY",
"state": "TN",
"postal_code": "377725782",
"telephone_number": "865-271-9536",
"fax_number": "865-986-0212"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKS",
"first_name": "KIMBERLY",
"middle_name": "GRIFFIN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-29",
"last_updated": "2012-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TN",
"license": "MD34033",
"primary": true
},
{
"code": "2080P0204X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Emergency Medicine",
"state": "TN",
"license": "MD34033",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1516025",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64054729",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3496552",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "4034474",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lenoir City, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.