Healthcare Provider Details

I. General information

NPI: 1295199933
Provider Name (Legal Business Name): KYMBERLY BROOKE MOYER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 HUNT CLUB BLVD STE 100
GALLATIN TN
37066
US

IV. Provider business mailing address

1529 HUNT CLUB BLVD STE 100
GALLATIN TN
37066-6066
US

V. Phone/Fax

Practice location:
  • Phone: 615-852-6480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3675
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: