Kimberly Paige Nelson, LPN

Individual provider Active NPI Licensed Practical Nurse · Jacksboro, TN

NPI 1477036234 · NPPES record last updated Sep 7, 2018

Key facts

NPI
1477036234
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
LPN0000064207 (TN)
Practice address
218 Indian Creek Rd
Jacksboro, TN 37757-3018
Phone
(423) 494-6300
Fax
(423) 377-1110
NPI assigned
Sep 7, 2018
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
LPN0000064207TNMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X LPN0000064207 TN Yes

Addresses

Primary practice location

218 Indian Creek Rd
Jacksboro, TN 37757-3018

Mailing address

218 Indian Creek Rd
Jacksboro, TN 37757-3018
Phone (423) 494-6300

Other names

  • Kimberly Phillips Nelson Former name

Other providers in Jacksboro, TN

All providers in Jacksboro, TN · Licensed Practical Nurse in Tennessee

Sources for this page

Verify at the official NPI Registry.