Healthcare Provider Details

I. General information

NPI: 1770645327
Provider Name (Legal Business Name): KIMBERLY S MCCASKILL M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 05/13/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 POPLAR AVE, STE. 1118
MEMPHIS TN
38157
US

IV. Provider business mailing address

5050 POPLAR AVE, STE. 1118
MEMPHIS TN
38157
US

V. Phone/Fax

Practice location:
  • Phone: 901-683-5658
  • Fax:
Mailing address:
  • Phone: 901-683-5658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1773
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: