Healthcare Provider Details

I. General information

NPI: 1588736896
Provider Name (Legal Business Name): KIMBERLY JOI COHEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8060 WOLF RIVER BLVD
GERMANTOWN TN
38138-1727
US

IV. Provider business mailing address

8060 WOLF RIVER BLVD
GERMANTOWN TN
38138-1727
US

V. Phone/Fax

Practice location:
  • Phone: 901-271-1000
  • Fax: 901-271-4187
Mailing address:
  • Phone: 901-271-1000
  • Fax: 901-271-4187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number122761
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15895
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: