Basic Information
| Provider Information | |||||||||
| NPI: | 1346316247 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ATKINS | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CRNA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ATKINS | ||||||||
| OtherFirstName: | KIM | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | CRNA | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 2930 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462062930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8444689496 | ||||||||
| FaxNumber: | 8556301300 | ||||||||
| Practice Location | |||||||||
| Address1: | 975 E THIRD ST | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374032147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237787806 | ||||||||
| FaxNumber: | 4237782360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2006 | ||||||||
| LastUpdateDate: | 09/21/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN68007 | TN | N | Nursing Service Providers | Registered Nurse | 367500000X | APN09335 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 8052355 | 05 | NC | MEDICAID | Q002762 | 05 | TN | MEDICAID | N410895 | 01 | GA | WELLCARE (GA MEDICAID) | OTHER | 009903020 | 05 | AL | MEDICAID | 3040167 | 01 | TN | BLUE CROSS BLUE SHIELD TN | OTHER | 000591533A | 05 | GA | MEDICAID | 430030815 | 01 | TN | RAILROAD MEDICARE | OTHER |