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General NPI Number Information
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NPI Number | 1427241421
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Entity Type | Individual
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Provider Name | KIMBERLY D. MATHIS NP
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Gender | Female
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 02/28/2019
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Provider Practice Location Address
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Address Line | 1600 MCARTHUR STREET
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City | MANCHESTER
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State | TN
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Zip | 37355
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Country | US
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Telephone | 931-723-7950
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Fax | 931-723-7815
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Provider Business Mailing Address
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Address Line | 1600 MCARTHUR STREET
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City | MANCHESTER
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State | TN
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Zip | 37355
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Country | US
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Telephone | 931-723-7950
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Fax | 931-723-7815
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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 | APN0000005806
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5806
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License Number State | TN
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