MEDICARE: MS. KIMBERLEY ROSE ADAMS RN

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
1	163W00000X	Registered Nurse	RN0000085631	TN

General Provider Information

NPI Number	:	1851420715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLEY ROSE ADAMS RN

Provider Business Mailing Address
First Line	:	1920 PICKWICK ST
Second Line	:
City	:	SAVANNAH
State	:	TN
Zip	:	38372-5309
Country	:	US
Telephone Number	:	731-925-2557
Fax Number	:	731-925-3100

Provider Business Practice Location Address
First Line	:	1920 PICKWICK ST
Second Line	:
City	:	SAVANNAH
State	:	TN
Zip	:	38372-5309
Country	:	US
Telephone Number	:	731-925-2557
Fax Number	:	731-925-3100

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/08/2007

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