1598834947 NPI number — KIM HALCOMB R.PH.

Table of content: KIM HALCOMB R.PH. (NPI 1598834947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598834947 NPI number — KIM HALCOMB R.PH.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALCOMB
Provider First Name:
KIM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.PH.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598834947
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7740 VERONA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POWELL
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37849-5339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-363-3400
Provider Business Mailing Address Fax Number:
865-986-4909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 ADESA BLVD
Provider Second Line Business Practice Location Address:
SUITE A150
Provider Business Practice Location Address City Name:
LENOIR CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-986-4530
Provider Business Practice Location Address Fax Number:
865-986-4909
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  C006969 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C006969 . This is a "PHARMACY LICENSE NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com