Healthcare Provider Details

I. General information

NPI: 1861366601
Provider Name (Legal Business Name): KIMBERLY ELAINE CLARK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY ELAINE WILLIAMS RN

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 TYSON AVE
PARIS TN
38242-4579
US

IV. Provider business mailing address

305 TYSON AVE
PARIS TN
38242-4579
US

V. Phone/Fax

Practice location:
  • Phone: 731-442-0687
  • Fax:
Mailing address:
  • Phone: 731-442-0687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number40083
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: