Healthcare Provider Details

I. General information

NPI: 1619936242
Provider Name (Legal Business Name): KIMBERLY COLLETTE YOUNG RNC MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5651 FRIST BLVD STE 201
HERMITAGE TN
37076
US

IV. Provider business mailing address

603 CANTERBURY TRIAL
MT JULIET TN
37122
US

V. Phone/Fax

Practice location:
  • Phone: 615-391-0800
  • Fax: 615-391-0431
Mailing address:
  • Phone: 615-758-3170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAPN0000006723
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: