Provider Demographics
NPI:1548722168
Name:KIBLER, FAYE MARIE (DO)
Entity type:Individual
Prefix:
First Name:FAYE
Middle Name:MARIE
Last Name:KIBLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:FAYE
Other - Middle Name:MARIE
Other - Last Name:TATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-239-2018
Mailing Address - Fax:
Practice Address - Street 1:10810 PARKSIDE DR STE 209
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1985
Practice Address - Country:US
Practice Address - Phone:865-251-3030
Practice Address - Fax:865-966-0191
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN58462081P2900X, 208VP0014X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine