MEDICARE: MRS. KIMERLY A NEAL FNP

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	363LP2300X	Primary Care Nurse Practitioner	APN0000005782	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4137186	OTHER	TN	BC/BS TN - MCMINNVILLE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4139731	OTHER	TN	BC/BS TN - CROSSVILLE

General Provider Information

NPI Number	:	1689668105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMERLY A NEAL FNP

Provider Business Mailing Address
First Line	:	300 20TH AVE N STE 403
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-5180
Country	:	US
Telephone Number	:	615-284-4088
Fax Number	:	615-284-7501

Provider Business Practice Location Address
First Line	:	401 SEWELL DR
Second Line	:
City	:	SPARTA
State	:	TN
Zip	:	38583-1223
Country	:	US
Telephone Number	:	931-738-4395
Fax Number	:	931-738-4330

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	08/20/2019

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