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NPI Code Detail

MEDICARE: KIMBERLY A TABOR D.O.

MEDICARE: KIMBERLY A TABOR D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation Physician1379TN
2207Q00000XFamily Medicine PhysicianDO1379TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1609869684
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY A TABOR D.O.
Provider Business Mailing Address
First Line : 1776 WOODSTEAD CT
Second Line : STE 208
City : THE WOODLANDS
State : TX
Zip : 77380-1480
Country : US
Telephone Number : 877-749-7428
Fax Number : 512-628-3314
Provider Business Practice Location Address
First Line : 1559 SPARTA ST
Second Line :
City : MCMINNVILLE
State : TN
Zip : 37110-1316
Country : US
Telephone Number : 931-815-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2005
Last Update Date : 12/03/2025

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Directions to “ KIMBERLY A TABOR D.O.” Practice Location

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