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NPI Code Detail

MEDICARE: KIMBERLY M RANDOLPH APN

MEDICARE: KIMBERLY M RANDOLPH APN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner7234TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144544982
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY M RANDOLPH APN
Provider Business Mailing Address
First Line : 3180 PROFESSIONAL PLZ
Second Line : STE 111
City : GERMANTOWN
State : TN
Zip : 38138-1534
Country : US
Telephone Number : 901-854-5455
Fax Number : 901-861-7736
Provider Business Practice Location Address
First Line : 3180 PROFESSIONAL PLZ
Second Line : STE 111
City : GERMANTOWN
State : TN
Zip : 38138-1534
Country : US
Telephone Number : 901-854-5455
Fax Number : 901-861-7736
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2010
Last Update Date : 04/01/2021

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Directions to “ KIMBERLY M RANDOLPH APN” Practice Location

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