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NPI Code Detail

MEDICARE: MS. JACQUELYN DELOIS KIMBALL MSN

MEDICARE: MS. JACQUELYN DELOIS KIMBALL MSN
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
1363LP2300XPrimary Care Nurse PractitionerAPN0000010667TN

General Provider Information

NPI Number : 1902802556
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JACQUELYN DELOIS KIMBALL MSN
Provider Business Mailing Address
First Line : 244 BURWOOD DR
Second Line :
City : MEMPHIS
State : TN
Zip : 38109-6755
Country : US
Telephone Number : 901-789-3137
Fax Number :
Provider Business Practice Location Address
First Line : 1056 E RAINES RD
Second Line :
City : MEMPHIS
State : TN
Zip : 38116-6337
Country : US
Telephone Number : 901-271-4900
Fax Number : 901-271-4911
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2005
Last Update Date : 07/08/2007

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