Healthcare Provider Details

I. General information

NPI: 1558394395
Provider Name (Legal Business Name): KIMBERLY HATLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5003 NORMANDY LN
MEMPHIS TN
38117-2701
US

IV. Provider business mailing address

3173 KIRBY WHITTEN RD STE 104
BARTLETT TN
38134-2881
US

V. Phone/Fax

Practice location:
  • Phone: 901-883-6611
  • Fax: 901-425-9939
Mailing address:
  • Phone: 901-384-8040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number406444
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11654
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: