Healthcare Provider Details

I. General information

NPI: 1053869354
Provider Name (Legal Business Name): KIMBERLY NOEL FLEMING PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 ALEXANDER ST
MEMPHIS TN
38111-4310
US

IV. Provider business mailing address

512 ALEXANDER ST
MEMPHIS TN
38111-4310
US

V. Phone/Fax

Practice location:
  • Phone: 859-229-3447
  • Fax:
Mailing address:
  • Phone: 859-229-3447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3378
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: