Healthcare Provider Details

I. General information

NPI: 1245732437
Provider Name (Legal Business Name): KIMBERLY MOYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 03/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 BEASLEY DR
DICKSON TN
37055-2841
US

IV. Provider business mailing address

175 BEASLEY DR
DICKSON TN
37055-2841
US

V. Phone/Fax

Practice location:
  • Phone: 615-441-1417
  • Fax:
Mailing address:
  • Phone: 615-441-1417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11716
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: