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NPI Code Detail

MEDICARE: KIMBERLY TANNER FAVA WHCNP, APRN

MEDICARE: KIMBERLY TANNER FAVA WHCNP, APRN
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
1363LW0102XWomen's Health Nurse Practitioner854373MS
2363LF0000XFamily Nurse Practitioner854373MS

General Provider Information

NPI Number : 1215195631
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY TANNER FAVA WHCNP, APRN
Provider Business Mailing Address
First Line : 8110 N BROTHER BLVD STE 200
Second Line :
City : BARTLETT
State : TN
Zip : 38133-2760
Country : US
Telephone Number : 901-255-5221
Fax Number : 901-373-4511
Provider Business Practice Location Address
First Line : 1204 MEDICAL PARK DR
Second Line :
City : OXFORD
State : MS
Zip : 38655-5326
Country : US
Telephone Number : 662-236-5717
Fax Number : 662-234-4016
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2008
Last Update Date : 03/03/2026

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