Healthcare Provider Details

I. General information

NPI: 1851384374
Provider Name (Legal Business Name): AMY CONE KIMBLE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 DANNY THOMAS PL MS 800
MEMPHIS TN
38105-3678
US

IV. Provider business mailing address

262 DANNY THOMAS PL MS 800
MEMPHIS TN
38105-3678
US

V. Phone/Fax

Practice location:
  • Phone: 901-495-3006
  • Fax: 901-495-3842
Mailing address:
  • Phone: 901-495-3006
  • Fax: 901-495-3842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number12071
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12071
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number154526
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: