Healthcare Provider Details

I. General information

NPI: 1083957880
Provider Name (Legal Business Name): KIMBERLY MICHELLE THORNTON P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY MICHELLE CARLON P.A.

II. Dates (important events)

Enumeration Date: 03/29/2013
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6716 NOLENSVILLE RD STE 210
BRENTWOOD TN
37027-8865
US

IV. Provider business mailing address

6716 NOLENSVILLE RD STE 210
BRENTWOOD TN
37027-8865
US

V. Phone/Fax

Practice location:
  • Phone: 615-941-7501
  • Fax: 615-941-7502
Mailing address:
  • Phone: 615-941-7501
  • Fax: 615-941-7502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0000002751
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: