Healthcare Provider Details

I. General information

NPI: 1821088600
Provider Name (Legal Business Name): KIMBERLY JILL SHIBAYAMA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY JILL WOODLEE PA-C

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 HARDING RD SUITE 1000
NASHVILLE TN
37205-2013
US

IV. Provider business mailing address

PO BOX 105132
ATLANTA GA
30348-5132
US

V. Phone/Fax

Practice location:
  • Phone: 615-383-2693
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1187
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA1187
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: