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General NPI Number Information
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NPI Number | 1164057865
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Entity Type | Individual
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Provider Name | KIMBERLY DAWN SWANNER DNP, AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/03/2020
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 877 JEFFERSON AVE
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City | MEMPHIS
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State | TN
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Zip | 38103-2807
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Country | US
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Telephone | 901-545-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 5879 HIGHWAY 315
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City | WATER VALLEY
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State | MS
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Zip | 38965-3043
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Country | US
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Telephone | 662-607-7077
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 880120
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 905370
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 32091
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License Number State | TN
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