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General NPI Number Information
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NPI Number | 1366704488
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Entity Type | Individual
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Provider Name | KIMBERLY ANNE TATUM N.P.
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Gender | Female
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Dates
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Enumeration Date | 06/14/2012
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Last Update Date | 09/11/2023
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Provider Practice Location Address
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Address Line | 4125 LAWNDALE DR
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City | GREENSBORO
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State | NC
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Zip | 27455-1885
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Country | US
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Telephone | 336-543-0786
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Fax | 336-234-5411
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Provider Business Mailing Address
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Address Line | 219 JUNIPER CREEK BLVD
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City | PINEHURST
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State | NC
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Zip | 28374-6819
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Country | US
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Telephone | 330-416-3833
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5005656
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5005656
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License Number State | NC
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