Provider Demographics
NPI:1174522049
Name:PEASLEE, KIMBERLY S (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:S
Last Name:PEASLEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 S MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-5998
Mailing Address - Country:US
Mailing Address - Phone:931-484-7531
Mailing Address - Fax:931-456-5686
Practice Address - Street 1:1645 S MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-5998
Practice Address - Country:US
Practice Address - Phone:931-484-7531
Practice Address - Fax:931-456-9515
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26006207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3800353Medicaid
TNG27694Medicare UPIN
TN3800353Medicaid