Healthcare Provider Details

I. General information

NPI: 1104702125
Provider Name (Legal Business Name): KIMBERLY ANN WARREN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 GERMANTOWN CT STE 207
CORDOVA TN
38018-4258
US

IV. Provider business mailing address

1585 STERLING DR
MEMPHIS TN
38119-6924
US

V. Phone/Fax

Practice location:
  • Phone: 901-878-3332
  • Fax:
Mailing address:
  • Phone: 901-414-8027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8199
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: