MEDICARE: DR. KIMBERLY RAY HINSON APN

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	6350	TN
2	363LP0200X	Pediatric Nurse Practitioner	6350	TN
3	363LF0000X	Family Nurse Practitioner	6350	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4078397	OTHER	TN	BLUE CROSS BLUE SHIELD #

General Provider Information

NPI Number	:	1679664411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY RAY HINSON APN

Provider Business Mailing Address
First Line	:	2409 HIGHWAY 70 E
Second Line	:
City	:	DICKSON
State	:	TN
Zip	:	37055-6126
Country	:	US
Telephone Number	:	615-879-1375
Fax Number	:

Provider Business Practice Location Address
First Line	:	2409 HIGHWAY 70 E
Second Line	:
City	:	DICKSON
State	:	TN
Zip	:	37055-6126
Country	:	US
Telephone Number	:	615-740-7322
Fax Number	:	615-740-7304

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	05/19/2026

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