KIMBERLY S BACON (NPI# 1215207451) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215207451 |
| Entity Type | Individual |
| Full Name | KIMBERLY S BACON |
| Credential | NP |
| Practice Address |
408 N State of Franklin Rd Suite 24 Johnson City TN 37604-6089 |
| Practice Telephone | 4234311810 |
| Practice Fax Number | 4234311811 |
| Mailing Telephone | 4234311810 |
| Mailing Fax Number | 4234311811 |
| Enumeration Date | 2012-01-05 |
| Last Update Date | 2017-01-26 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
15209 | TN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 1215207451 | 05 | |
| TN | 1527812 | 05 | |
| VA | 7100195690 | 05 | |
| KY | 7100195690 | 05 | |
| TN | RAILROAD MEDICARE PIN | P01200424 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366818452 | Kimberly Bacon | Counselor | 112 W Main St, Purcell, OK 73080-4220 | 2015-08-12 |
| 1487891065 | Kimberly Diane Bacon | Dental Assistant | 8381 La Palma Ave, Suite B & C, Buena Park, CA 90620-3271 | 2009-01-19 |
| 1205039542 | Kimberly Bacon | Social Worker | 50 Sanitorium Rd, Bldg F - Room 240, Pomona, NY 10970-3555 | 2007-06-06 |
| Street Address |
408 N STATE OF FRANKLIN RD SUITE 24 |
| City | JOHNSON CITY |
| State | TN |
| Zip Code | 37604-6089 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710981105 | Thomas R. Borthwick | Internal Medicine | 408 N State of Franklin Rd, Suite 24, Johnson City, TN 37604-6089 | 2005-06-13 |
| 1013364785 | Jill Hughes | Nurse Practitioner | 408 N State of Franklin Rd, Suite 12, Johnson City, TN 37604-6089 | 2016-05-23 |
| 1245685858 | Blue Ridge Medical Management Corporaiton | Internal Medicine | 408 N State of Franklin Rd, Ste 12, Johnson City, TN 37604-6089 | 2016-05-02 |
| 1619349578 | Blue Ridge Medical Management Corporation | Nurse Practitioner | 408 N State of Franklin Rd, Suite 31e, Johnson City, TN 37604-6089 | 2015-10-30 |
| 1679949572 | Julie Ann Reed | Nurse Practitioner | 408 N State of Franklin Rd, Suite 24, Johnson City, TN 37604-6089 | 2015-08-13 |
| 1962883678 | Blue Ridge Medical Management Corporation | Nurse Practitioner | 408 N State of Franklin Rd, Suite 31b, Johnson City, TN 37604-6089 | 2015-06-18 |
| 1811378854 | Blue Ridge Medical Management Corporation | Pediatrics | 408 N State of Franklin Rd, Suite 31d, Johnson City, TN 37604-6089 | 2015-06-16 |
| 1134500218 | Blue Ridge Medical Management Corporation | Nurse Practitioner | 408 N State of Franklin Rd, Suite 31c, Johnson City, TN 37604-6089 | 2015-06-15 |
| 1336541259 | Brooklyn Beaupre | Nurse Practitioner | 408 N State of Franklin Rd, Suite 24, Johnson City, TN 37604-6089 | 2014-09-23 |
| 1063823185 | Alexis Hodge Duty | Nurse Practitioner | 408 N State of Franklin Rd, Suite 31b, Johnson City, TN 37604-6089 | 2014-05-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417560707 | Brant Logan Nickens | Physical Therapist | 809 Lamont St and Veterans Way, Johnson City, TN 37604 | 2020-08-26 |
| 1952911562 | David Sandlin Hobbs | Pharmacist | Lamont St &, Veterans Way, Johnson City, Tn 37604, Johnson City, TN 37604 | 2020-08-07 |
| 1528688272 | Whitney Marie Ward | Physical Therapist | Lamont Street and Veterans Way, Johnson City, TN 37604 | 2020-04-23 |
| 1861050015 | Akesh Thomas | Student in an Organized Health Care Education/Training Program | Johnson City Medical Center, 400 N State of Franklin Rd, Johnson City, TN 37604 | 2019-06-03 |
| 1336629021 | Medical Education Assistance Corporation | Clinic/Center | 820 W Market St, Johnson City, TN 37604 | 2018-08-21 |
| 1093208951 | Lauren Tiffany Hayden | Physician Assistant | 403 N State of Franklin Rd Woodridge Hospital, Johnson City, TN 37604 | 2018-06-14 |
| 1174014450 | Jerica Moore | Specialist/Technologist | 1041 Hamiltion Place Dr., Johnson City, TN 37604 | 2018-05-23 |
| 1053809442 | Syed Ghazanfar Hasan | Student in an Organized Health Care Education/Training Program | Etsu Psychiatry and Behavioral Sciences Department, 1276 Gilbreath Dr., Johnson City, TN 37604 | 2018-05-01 |
| 1699262485 | Sonia Kumari Oad | Student in an Organized Health Care Education/Training Program | 178 West Maple St, Johnson City, TN 37604 | 2018-04-17 |
| 1821519364 | Mahmoud El Iskandarani | Internal Medicine | 1084 W Oakland Avenue, 748, Johnson City, TN 37604 | 2017-07-06 |
| Find all providers in zip 37604 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063025724 | Victoria Elizabeth Mcmanus | Nurse Practitioner | 365 Harry L Dr Ste 110, Johnson City, NY 13790-1471 | 2020-08-24 |
| 1649880139 | Amanda Danielle Ledford | Nurse Practitioner | 3 Enfield Ct, Johnson City, TN 37604-9101 | 2020-08-09 |
| 1861000135 | Deborah L Johnson | Nurse Practitioner | 2 Mcgregor Pl, Johnson City, TN 37604-1454 | 2020-07-22 |
| 1255978417 | William Mcguire | Nurse Practitioner | 176 Willocks Rd, Johnson City, TN 37601-6274 | 2019-12-06 |
| 1881248664 | Caiti Riden | Nurse Practitioner | 316 Marketplace Dr Ste 10, Johnson City, TN 37604-2595 | 2019-07-30 |
| 1699330282 | Courtney S Willis | Nurse Practitioner | 2203 N Greenwood Dr, Johnson City, TN 37604-7030 | 2019-05-08 |
| 1861955452 | Cindy Canter | Nurse Practitioner | 3552 Greenwood Dr, Johnson City, TN 37604-2834 | 2019-04-10 |
| 1366908980 | Holly Anne Parvin | Nurse Practitioner | 3209 W Walnut St, Johnson City, TN 37604-5949 | 2019-02-19 |
| 1891261376 | Lindsey Toney | Nurse Practitioner | 980 Smalling Rd, Johnson City, TN 37601-8208 | 2018-10-22 |
| 1821572868 | Karyn Kimberly Bruton | Nurse Practitioner | 1723 N Roan St, Johnson City, TN 37601-3949 | 2018-09-15 |
| Find all providers in JOHNSON CITY | ||||
| City | JOHNSON CITY |
| Zip Code | 37604 |
Please comment or provide details below to improve the information on KIMBERLY S BACON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.