MEDICARE: KIMBER WILSON

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	374U00000X	Home Health Aide	99-1725002	TN

General Provider Information

NPI Number	:	1740078757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBER WILSON

Provider Business Mailing Address
First Line	:	3540 SUMMER AVE STE 405
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38122-3633
Country	:	US
Telephone Number	:	901-896-9626
Fax Number	:

Provider Business Practice Location Address
First Line	:	3540 SUMMER AVE STE 405
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38122-3633
Country	:	US
Telephone Number	:	901-896-9626
Fax Number	:

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

Provider Enumeration Date	:	04/29/2025
Last Update Date	:	04/29/2025

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Directions to “ KIMBER WILSON ” Practice Location

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