KIMBERLY S BACON NP NPI 1215207451

NPI Information

NPI: 1215207451
Provider Name: KIMBERLY S BACON, NP
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
408 N STATE OF FRANKLIN RD
SUITE 24
JOHNSON CITY, TN
ZIP 37604
Phone: (423) 431-1810
Get Directions

Kimberly S Bacon, NP is a family nurse practitioner in Johnson City, TN. Kimberly S Bacon, NP NPI is 1215207451. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

408 N STATE OF FRANKLIN RD
SUITE 24
JOHNSON CITY, TN
ZIP 37604-089
Phone: (423) 431-1810
Fax: (423) 431-1811

The NPI 1215207451 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/5/2012 and was last updated on 1/26/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	15209	TENNESSEE	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	P01200424	OTHER	TENNESSEE	RAILROAD MEDICARE PIN
2	7100195690	MEDICAID	KENTUCKY
3	1215207451	MEDICAID	NORTH CAROLINA
4	103I506419	MEDICARE PIN	TENNESSEE
5	7100195690	MEDICAID	VIRGINIA
6	1527812	MEDICAID	TENNESSEE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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