Provider Demographics
NPI:1538359237
Name:PICKEL, KIMBERLY JO (FNP-BC, AOCNP)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:JO
Last Name:PICKEL
Suffix:
Gender:F
Credentials:FNP-BC, AOCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 WHITE AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-2300
Mailing Address - Country:US
Mailing Address - Phone:865-331-1720
Mailing Address - Fax:865-331-4398
Practice Address - Street 1:1915 WHITE AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2300
Practice Address - Country:US
Practice Address - Phone:865-331-1720
Practice Address - Fax:865-331-4398
Is Sole Proprietor?:No
Enumeration Date:2007-07-28
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000010454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3341277Medicaid