Healthcare Provider Details

I. General information

NPI: 1174741961
Provider Name (Legal Business Name): KIMBA ANNETTE MAYS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIM MAYS RN

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 N PARKWAY
JACKSON TN
38305-3058
US

IV. Provider business mailing address

1281 COTTON GROVE RD
JACKSON TN
38305-8215
US

V. Phone/Fax

Practice location:
  • Phone: 731-927-8529
  • Fax: 731-927-8600
Mailing address:
  • Phone: 731-423-0779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN0000095298
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: