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NPI Code Detail

MEDICARE: KIMBERLY ANNE TATUM N.P.

MEDICARE: KIMBERLY ANNE TATUM N.P.
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 Practitioner5005656NC
2363LF0000XFamily Nurse Practitioner5005656NC

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 : 1366704488
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY ANNE TATUM N.P.
Provider Business Mailing Address
First Line : 219 JUNIPER CREEK BLVD
Second Line :
City : PINEHURST
State : NC
Zip : 28374-6819
Country : US
Telephone Number : 330-416-3833
Fax Number :
Provider Business Practice Location Address
First Line : 4125 LAWNDALE DR
Second Line :
City : GREENSBORO
State : NC
Zip : 27455-1885
Country : US
Telephone Number : 336-543-0786
Fax Number : 336-234-5411
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2012
Last Update Date : 09/11/2023

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Directions to “ KIMBERLY ANNE TATUM N.P.” Practice Location

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