Healthcare Provider Details

I. General information

NPI: 1164474599
Provider Name (Legal Business Name): KIMBERLY JONES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N FANT ST
ANDERSON SC
29621-5708
US

IV. Provider business mailing address

1900 EXETER RD SUITE 210
GERMANTOWN TN
38138-2954
US

V. Phone/Fax

Practice location:
  • Phone: 864-512-8000
  • Fax:
Mailing address:
  • Phone: 901-818-2160
  • Fax: 901-682-9522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28562
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 112406
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN 10513
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: