MEDICARE: KIMBERLY D SPENCER RN

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	176B00000X	Midwife	38	TN
2	163WS0200X	School Registered Nurse	231177	TN

General Provider Information

NPI Number	:	1780721811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY D SPENCER RN

Provider Business Mailing Address
First Line	:	2500 CHARLOTTE AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-4129
Country	:	US
Telephone Number	:	615-340-7781
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 CHARLOTTE AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-4129
Country	:	US
Telephone Number	:	615-340-7781
Fax Number	:

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	08/20/2019

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