Healthcare Provider Details

I. General information

NPI: 1457316630
Provider Name (Legal Business Name): KIMBERLY ANN PERRY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 TULLAHOMA HWY
WINCHESTER TN
37398-4940
US

IV. Provider business mailing address

3651 TULLAHOMA HWY
WINCHESTER TN
37398-4940
US

V. Phone/Fax

Practice location:
  • Phone: 931-962-4082
  • Fax: 931-962-4084
Mailing address:
  • Phone: 931-962-4082
  • Fax: 931-962-4084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6754
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: